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Yongpisarn T, Namasondhi A, Iamsumang W, Rattanakaemakorn P, Suchonwanit P. Liver fibrosis prevalence and risk factors in patients with psoriasis: A systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:1068157. [PMID: 36590962 PMCID: PMC9797863 DOI: 10.3389/fmed.2022.1068157] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
Background Patients with psoriasis are more likely than matched controls in the general population to have advanced liver fibrosis; however, our understanding of these patients is limited. There is currently no systematic evaluation of the prevalence and risk factors of liver fibrosis in psoriasis patients. Objective To evaluate the prevalence of psoriasis patients who are at high or low risk for advanced liver fibrosis and determine the risk factors for developing liver fibrosis. Methods Electronic searches were conducted using the PubMed, Embase, Scopus, and Cochrane Library databases from the dates of their inception till May 2022, using the PubMed, Embase, Scopus, and Cochrane Library databases. Any observational study describing the prevalence and/or risk factors for liver fibrosis in patients with psoriasis was included. Results Patients with psoriasis at high risk for advanced liver fibrosis had a pooled prevalence of 9.66% [95% confidence interval (CI): 6.92-12.75%, I 2 = 76.34%], whereas patients at low risk for advanced liver fibrosis had a pooled prevalence of 77.79% (95% CI: 73.23-82.05%, I 2 = 85.72%). Studies that recruited methotrexate (MTX)-naïve patients found a lower prevalence of advanced liver fibrosis (4.44, 95% CI: 1.17-9.22%, I 2 = 59.34%) than those that recruited MTX-user cohorts (12.25, 95% CI: 6.02-20.08%, I 2 = 82.34%). Age, sex, BMI, PASI score, psoriasis duration, MTX cumulative dose, and the prevalence of obesity, MTX users, diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome were not identified as sources of heterogeneity by meta-regression analysis. The pooled odds ratios for age >50 years, BMI > 30, diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome were 2.20 (95% CI: 1.42-3.40, I 2 = 0%), 3.67 (95% CI: 2.37-5.68, I 2 = 48.8%), 6.23 (95% CI: 4.39-8.84, I 2 = 42.4%), 2.82 (95% CI: 1.68-4.74, I 2 = 0%), 3.08 (95% CI: 1.90-4.98, I 2 = 0%), and 5.98 (95% CI: 3.63-9.83, I 2 = 17%), respectively. Conclusion Approximately 10% of the population with psoriasis is at high risk for advanced liver fibrosis, while 78% are at low risk. Patients over the age of 50 with obesity, diabetes, hypertension, dyslipidemia, and/or metabolic syndrome have an increased risk of developing liver fibrosis, necessitating monitoring. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022303886], identifier [CRD42022303886].
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Hepatotoxic potentials of methotrexate: Understanding the possible toxicological molecular mechanisms. Toxicology 2021; 458:152840. [PMID: 34175381 DOI: 10.1016/j.tox.2021.152840] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/10/2021] [Accepted: 06/22/2021] [Indexed: 12/12/2022]
Abstract
Methotrexate (MTX) is one of the most effective and widely used drugs in the management of autoimmune and dermatological diseases. Rheumatoid arthritis and psoriasis patients who are under long term MTX-therapy are at high risk of developing a liver injury. Accumulation of intracellular MTX-polyglutamate (MTX-PG), a metabolite of MTX triggers oxidative stress, inflammation, steatosis, fibrosis, and apoptosis in hepatocytes. MTX-PG causes oxidative stress in the liver by inducing lipid peroxidation thereby releasing reactive oxygen species and suppressing antioxidant response elements. MTX-PG induces several pro-inflammatory signaling pathways and cytokines such as tumor necrosis factor-α, nuclear factor kappa B and interleukin 6 (IL-6), IL- β1, IL-12. MTX-PG depletes hepatic folate level and decreases RNA and DNA synthesis leading to hepatocyte death. MTX-PG inhibits 5-aminoimidazole-4-carboxamide ribonucleotide transformylase enzyme and thereby causes accumulation of intracellular adenosine, which causes activation of hepatic stellate cells, extracellular matrix accumulation and hepatic fibrosis. MTX-PG induces hepatocytes apoptosis by activation of caspase 3 via the intrinsic pathway. Clinically, aggravation of underlying fatty liver to non-alcoholic steatohepatitis with fibrosis seems to be an important mechanism of liver injury in MTX-treated RA patients. Therefore, there is a need for monitoring liver injury in RA, psoriatic and cancer patients with NAFLD and fibrosis risk factors during MTX treatment. This review summarizes the possible molecular mechanism of MTX-induced hepatotoxicity. It may pave the way for early detection of liver injury and develop novel strategies for treating MTX mediated hepatotoxicity.
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Larsen JB, Knudsen CS, Parkner T. Procollagen III, N-terminal propeptide (PIIINP): establishment of reference intervals in Northern European adults and children using the MAGLUMI 800 chemiluminescence immunoassay. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:389-393. [PMID: 34057372 DOI: 10.1080/00365513.2021.1929444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Procollagen III, N-terminal propeptide (PIIINP) is used as a biomarker for increased collagen III-synthesis. Reference intervals have not been established for the MAGLUMI 800 chemiluminescence immunoassay (CLIA) in Northern European adults or in children. The present study aimed to establish age-specific reference intervals in a Northern European population. PIIINP serum levels were analysed in healthy blood donors 19-67 years (n = 240) and children 2-18 years (n = 420). Furthermore, we investigated total imprecision and stability at room temperature and at -20 °C and performed a method comparison between MAGLUMI 800 CLIA (Snibe Diagnostics, Shenzhen, China) and ADVIA Centaur CP (Siemens Healthcare Diagnostics, Tarrytown, NY,USA). PIIINP was influenced by age but not sex. We established the following reference intervals: 2-10 years, 18-62 µg/L; 11-18 years, 15-75 µg/L; 19-39 years, 15-55 µg/L; 40-67 years, 14-31 µg/L. Total imprecision for PIIINP on MAGLUMI 800 was acceptable with coefficients of variation of 4.9% in the low range and 9.4% in the high range. PIIINP was stable for 24 h at room temperature after centrifugation and for at least 7 months at -20 °C. MAGLUMI 800 yielded significantly higher PIIINP levels than ADVIA Centaur CP. In conclusion, we established age-specific reference intervals for PIIINP using MAGLUMI 800 CLIA in a large Danish cohort. Our results may be useful for other laboratories wishing to establish PIIINP on the same platform and may provide improved guidance for medical doctors treating both children and adults with fibrotic disorders.
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Affiliation(s)
| | | | - Tina Parkner
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
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van der Kraaij GE, Balak DMW, Busard CI, van Cranenburgh OD, Chung Y, Driessen RJB, de Groot M, de Jong EMGJ, Kemperman PMJH, de Kort WJA, Karsch SA, Lamberts A, Lecluse LLA, van Lümig PPM, Menting SP, Prens EP, van den Reek JMPA, Seyger MMB, Thio HB, Veldkamp WR, Wakkee M, Nast A, Jacobs A, Rosumeck S, Spuls Chair PI. Highlights of the updated Dutch evidence- and consensus-based guideline on psoriasis 2017. Br J Dermatol 2019; 180:31-42. [PMID: 30604536 PMCID: PMC6849803 DOI: 10.1111/bjd.17198] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2018] [Indexed: 12/31/2022]
Abstract
Linked Comment: https://doi.org/10.1111/bjd.17390.
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Affiliation(s)
- G E van der Kraaij
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Dutch Society of Dermatology and Venereology, Utrecht, the Netherlands
| | - D M W Balak
- University Medical Centre Utrecht, Utrecht, the Netherlands
| | - C I Busard
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - O D van Cranenburgh
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Dutch Skin Foundation, Nieuwegein, the Netherlands
| | - Y Chung
- Dutch Society of Dermatology and Venereology, Utrecht, the Netherlands
| | - R J B Driessen
- Radboud University Medical Centre, Nijmegen, the Netherlands
| | - M de Groot
- Antonius Hospital, Sneek/Emmeloord, the Netherlands
| | - E M G J de Jong
- Radboud University Medical Centre, Nijmegen, the Netherlands.,Radboud University Nijmegen, the Netherlands
| | - P M J H Kemperman
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Waterlandziekenhuis, Purmerend, the Netherlands
| | | | - S A Karsch
- Dutch Society of Dermatology and Venereology, Utrecht, the Netherlands
| | - A Lamberts
- Dutch Society of Dermatology and Venereology, Utrecht, the Netherlands.,University Medical Center Groningen, Groningen, the Netherlands
| | - L L A Lecluse
- Bergman Clinics and U-clinic, Amsterdam, the Netherlands
| | - P P M van Lümig
- Radboud University Medical Centre, Nijmegen, the Netherlands
| | - S P Menting
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - E P Prens
- Erasmus Medical Centre, Rotterdam, the Netherlands
| | | | - M M B Seyger
- Radboud University Medical Centre, Nijmegen, the Netherlands
| | - H B Thio
- Erasmus Medical Centre, Rotterdam, the Netherlands
| | - W R Veldkamp
- Dutch Society of Dermatology and Venereology, Utrecht, the Netherlands.,Radboud University Nijmegen, the Netherlands
| | - M Wakkee
- Erasmus Medical Centre, Rotterdam, the Netherlands
| | - A Nast
- Department of Dermatology, Venereology und Allergy, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - A Jacobs
- Department of Dermatology, Venereology und Allergy, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - S Rosumeck
- Department of Dermatology, Venereology und Allergy, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - P I Spuls Chair
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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