Psoriatic Arthritis and Fatty Liver Disease: Psoriatic arthritis (PsA) is a type of arthritis. An estimated 520,000 patients are affected with psoriatic arthritis in the US population. Psoriasis is a skin disease that causes red, scaly rashes, most commonly on the elbows, hands, feet, ankles, and knees.
Most people get psoriasis years before psoriasis is diagnosed. But for some people, joint problems begin before or at the same time as skin blemishes.
Fatty liver is disease causes buildup of fats in the liver. You may have heard that doctors call this hepatic steatosis. Fatty liver disease cause problems for your liver to work. There are two main types of fatty liver: non-alcoholic fatty liver disease (NAFLD) and alcohol-induced fatty liver disease, also known as alcoholic steatohepatitis.
Psoriatic Arthritis and Fatty Liver Disease
As many as 47 percent of psoriasis patients develop the non-alcoholic fatty liver disease (NAFLD) a potentially life-threatening condition associated with the accumulation of non-alcoholic fatty liver disease. The relationship between psoriasis and non-alcoholic fatty liver disease (NAFLD) is not fully understood, however, may have something to do with a group of health risk factors called metabolic syndrome.
Psoriatic arthritis and fatty liver disease both increase the heart disease risk. It is not clear whether NAFLD and psoriasis together carry a higher risk of cardiovascular disease than having any of these diseases alone.
Psoriasis is a common inflammatory disease that is linked with several other co-morbidities. Patients with psoriasis have a higher incidence of non-alcoholic fatty liver condition compared to controls. There is a high risk of liver fibrosis and more severe skin disease in patients with psoriasis and non-alcoholic fatty liver disease. 
In western countries, non-alcoholic fatty liver disease is the most common liver disease. Patients with psoriasis have a higher risk of developing non-alcoholic fatty liver disease and a higher risk of developing more severe types of disease with worse outcomes. 
The link between NAFLD and psoriasis seems to be that metabolic syndrome, is more common in patients with psoriasis and is a risk factor for NAFLD. Metabolic syndrome increases the risk of obesity, lipid disorders, hypertension, and type 2-diabetes – represent the development of NAFLD.
Metabolic syndrome is the name of risk factors that increases stroke and diabetes risk, and other health problems like heart disease. Your doctor will diagnose your metabolic syndrome based on the results of physical examinations and blood tests.
To diagnose metabolic syndrome you must have at least three of the five metabolic risk factors.
Metabolic Risk Factors
A wide waist means that you are overweight around the waist (belly fat). You can measure your waist with your doctor to see if you have a large waistline.
Waist circumference measurement in women 35-inches or more, and in men 40-inches or more is a metabolic risk factor. Having a big waist means you have a higher risk of heart disease and other health problems.
High Levels of Triglycerides
Triglycerides are present in blood and are a type of fat. Having 150 mg/dl or higher levels of triglyceride or drugs used to treat high triglycerides is a metabolic risk factor. (Mg/dl are milligrams per deciliter, it is a measuring unit for blood sugar, triglycerides, and cholesterol.
Low HDL Cholesterol
HDL (High-density lipoprotein) is called good cholesterol because it aids in removing other forms of cholesterol from your blood.
HDL cholesterol levels below 50 mg/dl in women and below 40 mg/dl in men, or drugs used to treat low HDL cholesterol are metabolic risk factors.
High Blood Pressure
130/85 mmHg (millimeter of mercury) blood pressure or more than this, or medicines used to treat high blood pressure is a metabolic risk factor. (an mmHg is a measuring unit for blood pressure measurement).
If only one of your two blood pressure values is high, you are still at risk of metabolic syndrome.
High Fasting Blood Sugar
During fasting, the normal level of blood sugar is below 100 mg/dl. 100-125 mg/dl blood glucose levels during fasting are considered prediabetes. Having 126 mg/dl or higher blood sugar levels during fasting are considered diabetic.
100 mg/dl or higher blood glucose levels during fasting, or using medicines for the treatment of high blood sugar are metabolic risk factors.
Approx. 85% of people with type 2 diabetes (the most common type of diabetes) also have metabolic syndrome. These people are at higher risk of heart disease than 15% of people with type 2 diabetes without metabolic syndrome.
What are the signs and symptoms of fatty liver?
Patients that have fatty liver usually have no symptoms until the disease progresses to cirrhosis. If a person has symptoms, they may be:
- Abdominal pain or a feeling of fullness in the upper right corner of the abdomen.
- Weight loss, loss of appetite, or nausea.
- Yellowing of the eyes and yellow skin.
- Legs and abdomen swelled (edema).
- Excessive fatigue or mental confusion.
What are the Symptoms of Psoriatic Arthritis?
Psoriatic arthritis symptoms vary from person to person. Symptoms may be:
- Scaly, swollen patches of skin, usually on elbows, scalp, or knees.
- Stiffness of joints, pain, and inflammation in one or more joints.
- Patient often feels tired (fatigue) or has no energy.
- Sensitivity in the area where ligaments or tendons attach to bone. Common places are the sole and back of the heel.
- Painful, like sausage swelling of a toe or entire finger.
- Nail changes, such as dents or deterioration. Also, nails can separate from the nail bed.
- Inflammation of the eye, particularly middle eye layer inflammation. Due to this eye pain can occur, blurred vision which needs to be treated as soon as possible to prevent vision damage.
Psoriasis is an immune-mediated serious inflammatory illness, and is not limited to the skin, but may be linked with arthritis, metabolic syndrome, including, cardiovascular diseases, obesity, and diabetes.
It is recently reported that non-alcoholic fatty liver disease (NAFLD) occurs in approx. 50 percent of all psoriasis patients. NAFLD is identified by the buildup of fat in liver cells without excessive alcohol consumption.
It is debatable whether systemic inflammation behind psoriasis contributes to the development of NAFLD or whether comorbidities such as obesity contribute to the development of NAFLD.
Early diagnosis of non-alcoholic fatty liver disease (NAFLD), and to understanding its pathophysiology better in the context of generalized psoriasis is therefore important for the individual treatment approach.