Agoglia L, Chindamo MC, Villela-Nogueira C. Psoriasis, metabolic syndrome and methotrexate: Is this association suitable for a new subcategory in steatotic liver disease? World J Hepatol 2025; 17(4): 102978 [DOI: 10.4254/wjh.v17.i4.102978]
Corresponding Author of This Article
Cristiane Villela-Nogueira, MD, PhD, Professor, Department of Internal Medicine, School of Medicine and Hepatology Division, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco 255 room 9E16, Rio de Janeiro 21941-913, Brazil. crisvillela@hucff.ufrj.br
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Apr 27, 2025; 17(4): 102978 Published online Apr 27, 2025. doi: 10.4254/wjh.v17.i4.102978
Psoriasis, metabolic syndrome and methotrexate: Is this association suitable for a new subcategory in steatotic liver disease?
Luciana Agoglia, Maria Chiara Chindamo, Cristiane Villela-Nogueira
Luciana Agoglia, Department of Internal Medicine, School of Medicine, Section of Gastroenterology, Hospital Universitário Antônio Pedro, Federal University Fluminense, Niterói 24033-900, Rio de Janeiro, Brazil
Maria Chiara Chindamo, Cristiane Villela-Nogueira, Department of Internal Medicine, School of Medicine and Hepatology Division, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
Co-first authors: Luciana Agoglia and Maria Chiara Chindamo.
Author contributions: Agoglia L and Chindamo MC contributed equally as co-first authors; Agoglia L performed a critical literature review, prepared the manuscript, and wrote it; Chindamo MC and Villela-Nogueira C provided input in writing the paper and performed a critical review of the manuscript; and all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cristiane Villela-Nogueira, MD, PhD, Professor, Department of Internal Medicine, School of Medicine and Hepatology Division, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco 255 room 9E16, Rio de Janeiro 21941-913, Brazil. crisvillela@hucff.ufrj.br
Received: November 5, 2024 Revised: March 8, 2025 Accepted: March 27, 2025 Published online: April 27, 2025 Processing time: 172 Days and 19 Hours
Abstract
Psoriasis is a prevalent inflammatory disease that shares chronic inflammation pathways with the pathophysiology of metabolic syndrome (MetS), type-2 diabetes mellitus and atherosclerosis. A high prevalence of steatosis and advanced liver fibrosis has been described in psoriasis. The influence of MetS and its compounds, patatin-like phospholipase domain containing 3 and transmembrane 6 superfamily member 2 gene polymorphisms and the cumulative dose of methotrexate (MTX) in the progression of steatotic disease are still under debate. A suitable new classification for psoriasis-related liver disease, under the umbrella of steatotic liver disease (SLD), might be evaluated due to the potential impact of MTX on liver steatosis. Considering the interplay between the MetS, steatosis and MTX, a new definition for this complex disease might be discussed since it is not entirely addressed under the umbrella of SLD and metabolic-dysfunction associated SLD. Hence, shortly, a discussion could be raised on the feasible term “Met-Drug SLD”, metabolic and drug-induced SLD, which comprises both metabolic dysfunction and drug-related SLD. This review aims to report the best evidence to accurately classify liver disease in psoriasis, considering the new definition of SLD, allowing appropriate management once it is carefully defined.
Core Tip: The prevalence of metabolic syndrome and steatosis is higher in patients with psoriasis; the concept of the hepato-dermal axis shows common inflammatory pathways between steatotic liver and psoriatic skin. The interplay between metabolic dysfunction and the use of methotrexate in patients with psoriasis might raise questions about whether a new subcategory under the umbrella of steatotic liver disease might be considered.
