Dr Danielle Brandman explores the impact of metabolic dysfunction–associated steatotic liver disease (MASLD) in individuals with psoriatic disease.
Professor of Clinical Medicine, Division of Gastroenterology and Hepatology, Division of Medicine, Weill Cornell Medicine; Medical Director of Liver Transplantation, NewYork-Presbyterian/Weill Cornell, New York, NY
It can get really tricky because some of the patterns of injury from methotrexate may match what we see in MASLD. People who have psoriatic disease and MASLD may have that common risk factor of obesity and diabetes. It can be really tough to tease out.
If you are treated with methotrexate, your doctor is going to monitor your liver enzymes closely. If the liver enzymes are elevated, particularly before methotrexate starts, then you should be connected to a hepatologist for further evaluation. Outside of a hepatologist practice, your doctor can help determine whether you're at risk of having advanced fibrosis. One of those ways is by using some routine blood tests, such as platelet count and liver enzymes, to calculate ascore. The FIB-4 value may help classify whether you're at low, high, or intermediate risk of having significant liver disease.
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