High prevalence of MASLD in psoriasis and psoriatic arthritis assessed with multiparametric magnetic resonance imaging.

Objectives: Psoriatic disease (PsD) is a chronic inflammatory condition associated with obesity, metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (MASH). We aimed to determine the prevalence of MASLD/MASH in a real-world psoriatic cohort using advanced imaging.

Methods: COLIPSO is a multicentre, prospective study of adults with PsD receiving standard systemic therapy in secondary care. Fifty participants underwent clinical assessments and non-invasive tests of liver health, including MRI-biomarkers of liver fibro-inflammation and fat content. These were compared with 360 individuals with PsD, with 150 controls without PsD (matched for age, sex, BMI and comorbidities) and 150 healthy controls from the UK Biobank and COVERSCAN studies. Associations were investigated with Spearman's rank correlations and multivariate linear regression models.

Results: The prevalence of steatotic liver disease was 44% in the PsD group (aged 48 years, 58% male, BMI 29 kg/m2) and higher than in matched controls (25%, p= 0.02). MASH was prevalent in 22% of PsD patients (vs 3% in matched controls, p< 0.001). Thirteen of the 24 (54%) individuals with PsD and liver disease had normal liver function blood tests. No significant difference in levels of liver disease was observed between those with or without prior exposure to methotrexate.

Conclusions: Individuals with PsD exhibit higher prevalence of MASLD and MASH that was missed by blood tests and was present even in individuals with no methotrexate exposure. These findings underscore the importance of routine MASLD screening in this population with more sensitive tools, such as multi parametric MRI.