Pos0944 the Burden of Metabolic Dysfunction–associated Steatotic Liver Disease (Masld) in Patients With Inflammatory Arthritis at Onset and the Role of Coexisting Psoriasis

Background: In 2023 a Delphi consensus statement of three large pan-national liver associations renamed non-alcoholic fatty liver disease (NAFLD) to metabolic dysfunction–associated steatotic liver disease (MASLD) (1). MASLD is primarily a metabolic disease, namely the liver's manifestation of the metabolic syndrome. Objectives: Based on the relevance of metabolic comorbidities in patients with inflammatory arthritis, we aimed to explore the burden of MASLD at disease onset in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA). Methods: Patients at the time of SpA or RA diagnosis fulfilling the 2009 ASAS or the ACR/EULAR RA classification criteria were eligible for inclusion provided that abdomen US scan, hepatitis B and C virus serological markers, complete data on alcohol intake and on previous/concurrent treatments were available. We also calculated the fibrosis (FIB)-4 score that can be applied to patients with MASLD aged between 35 and 65 years (FIB-4 score <1.3 no advanced fibrosis; 1.3-2.6 the patient requires further testing; >2.67 advanced fibrosis) (2). Results: 136 patients fulfilled the inclusion criteria, 44 (32%) had evidence of hepatic steatosis on imaging and of these 44 patients, 39 (89%) fulfilled the criteria for MASLD (Figure 1). Females had an increased risk of having MASLD (unadjusted odds ratio (OR) and 95% confidence interval (CI) =3.3; 1.2-9.3) and this was independent on age and on being diagnosed with RA or SpA (adjusted OR=3.4 95% CI = 1.1-10.9). MASLD was equally frequent in obese and non-obese patients and the prevalence of hypercholesterolemia, hypertriglyceridemia, type 2 diabetes and arterial hypertension was similar in patients with or without MASLD. SpA patients with MASLD mainly fulfilled peripheral ASAS criteria and <20% showed HLA-B*27. Psoriasis was twice more frequent in SpA patients with MASLD, compared to those without MASLD (OR=4.16; 95% CI 1.3-13.6). The association between female sex and MASLD was no longer significant when adjusting for the presence of psoriasis. No difference in the prevalence of positive rheumatoid factor and/or anti-cyclic citrullinated peptides was observed in RA patients with or without MASLD. None of the patients with MASLD aged 35-65 years showed a FIB-4 score >2.67, however, the score was between 1.3 and 2.67 in 15% of patients warranting additional investigations. Conclusion: MASLD can be detected in up to one third of patients with inflammatory arthritis at disease diagnosis and in a small but relevant proportion of patients it may already be progressing towards fibrosis. Patients with psoriasis should be carefully assessed for MASLD even before the development of musculoskeletal manifestations. REFERENCES: [1] Rinella ME et al. Hepatology 2023; 78(6): 1966-1986 [2] Alkouri N et al. Gastroenterol Hepatol (N Y). 2012;8(10):661-8 Acknowledgements: NIL. Disclosure of Interests: None declared.