For psoriasis patients who have elevated hepatic steatosis and are receiving methotrexate, a noninvasive test can be used to help monitor for risk of worsening fibrosis, according to a study published in JAMA Dermatology.

Bruce Bauer, MD, from Pariser Dermatology Specialists in Norfolk, Va., and colleagues conducted a retrospective descriptive analysis among a cohort of patients with psoriasis treated with methotrexate sodium therapy who underwent nonalcoholic steatohepatitis (NASH) FibroSure testing at a dermatology referral center at a single institution. Patients were excluded if they were younger than 18 years of age, had received methotrexate therapy for another indication, had received less than a 500-mg cumulative dose of methotrexate, or had been taking methotrexate for fewer than 90 days.

The study included 107 patients who received a diagnosis of psoriasis from January 1, 2007, to December 31, 2013. Data analysis was performed from January 1 to December 31, 2014. The primary outcome was NASH FibroSure risk scores suggesting the development and progression of hepatic fibrosis in patients with psoriasis receiving long-term methotrexate therapy.

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Of 107 patients who had a NASH FibroSure test performed any time during therapy, a statistically significant correlation between worsening fibrosis scores and cumulative MTX dose was observed in women (Spearman ρ = 0.21) but not in men (Spearman ρ = 0.17). The correlation for women remained significant after the researchers corrected multiple NASH FibroSure tests. For women, a statistically significant correlation was found between a BMI of 28 or more and worsening fibrosis scores (Spearman ρ = 0.2) and no significant correlation was observed between the combination of age older than 65 years and worsening of hepatic fibrosis scores with cumulative methotrexate dose. No differences were observed between men and women with regard to prevalence of a BMI of 28 or more, diabetes, age older than 65 years, or chronic kidney disease.

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“In a single-institution cohort, these results suggest that NASH FibroSure may be used, especially among female patients, to help monitor for risk of worsening fibrosis during methotrexate therapy,” the authors concluded.


  1. Bauer B, Chyou PH, Stratman EJ, Green C, et al. Noninvasive testing for nonalcoholic steatohepatitis and hepatic fibrosis in patients with psoriasis receiving long-term methotrexate sodium therapy. JAMA Dermatol. 2017 Aug 23. doi: 10.1001/jamadermatol.2017.2083