A multidisciplinary team-based approach to reduce non-alcoholic fatty liver disease-related fibrosis in patients with psoriasis

Purpose: Psoriasis impacts approximately 7.5 million people in the United States and recent studies support the link between psoriasis and non-alcoholic fatty liver disease (NALFD). The majority of psoriasis patients are not being screened for NAFLD. All clinicians must be aware of this association so they can recognize and provide a proper follow-up and medication selection in psoriasis patients to prevent NAFLD. The aim of this review is to explore the current evidence within the last decade with respect to the association between the pathophysiological mechanisms of psoriasis and NAFLD. A secondary aim is to highlight the importance of utilizing a multidisciplinary patient care team to manage moderate-to-severe psoriasis. Methods: A systematic review was conducted using Pubmed, Scopus, and International Pharmaceutical Abstracts databases between 2006-2016. Key search terms included ‘Psoriasis,’ ‘Patient Care Team,’ ‘Multidisciplinary approach,’ ‘Metabolic Disease,’ ‘Obesity,’ ‘Psoriatic Arthritis,’ and ‘Mental disorders.’ Abstracts were screened against inclusion criteria and selected based upon relevance and quality. Randomized controlled trials, prospective and retrospective studies were excluded if they were not in English or lacked information on moderate and severe psoriasis. Once articles were retrieved, they were evaluated based on the Oxford Centre for Evidence-Based Medicine and summarized in a table structured by Title, Author, Research Question, Inclusion Criteria, Resources, Findings, and Quality. Results: The search yielded a total of 33 studies for review. The articles retrieved have shown a strong association between NAFLD and psoriasis. Psoriasis patients should be routinely screened for NAFLD and the presence of NAFLD should be taken into consideration when choosing pharmacological treatment to reduce the progression of liver disease. Multidisciplinary patient care team management (pharmacists, dermatologists, psychologists and dietitians) should include monitoring for metabolic disease, osteoporosis, and mental health assessment. Conclusions: Psoriasis patients who have multiple comorbidities can benefit from multidisciplinary team care. A unique opportunity exists to screen psoriasis patients with multiple comorbidities or not well managed on current therapy for NAFLD, which is predicted to be the leading cause of liver transplantation by 2020. Few studies have explored the supportive role of pharmacists for patients with psoriasis. Future research is warranted.