Psoriasis linked to liver disease, substance misuse and interstitial lung disease

Design

Matched cohort, phenome-wide analysis of linked UK primary and hospital records

Population

320,220 people with psoriasis vs 1,706,424 matched controls

Primary outcome

Hospital-recorded diagnoses across 225 ICD-10 blocks

Effect

Liver disease HR 1.47 (99% CI 1.42 to 1.51); interstitial lung disease HR 1.33 (1.27 to 1.40)

This UK study used linked primary care and hospital records to compare 320,220 people with psoriasis with 1,706,424 people matched on age, sex and general practice. The authors ran a separate analysis for each of 225 blocks of hospital diagnoses, adjusting for alcohol, smoking, body mass index and deprivation.

Psoriasis was associated with outcomes across most organ systems. Among the strongest long-term non-skin associations were liver disease (HR 1.47, 99% CI 1.42 to 1.51), substance misuse including alcohol and tobacco (HR 1.26, 1.25 to 1.28) and interstitial lung disease (HR 1.33, 1.27 to 1.40). The absolute risk differences were modest, largest for substance misuse.

These are associations, and the authors present them as a map for further study rather than proof of cause. But liver disease and alcohol use already shape systemic drug choice in psoriasis, and the lung signal is worth keeping in mind for methotrexate and for patients with unexplained breathlessness.

• Ask about alcohol and tobacco use at psoriasis reviews and record it
• Check liver tests and metabolic risk before choosing a systemic agent
• Take new breathlessness or a dry cough seriously in psoriasis patients, especially on methotrexate
• Share the cardiometabolic and liver risk picture with the patient's GP

Why it matters

Liver disease and alcohol use already narrow systemic options in psoriasis, so finding them early changes treatment choice.

Don't overread it

Observational associations across many tests — this does not show psoriasis causes these conditions.

The statistics, in plain English

A hazard ratio of 1.47 means about 47% higher risk over time compared with matched people. The authors used 99% rather than 95% intervals because they tested 225 outcomes, which makes chance findings less likely. Absolute differences were small for most conditions.

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