Prevalence of Nonalcoholic Fatty Liver Disease in Patients With Rheumatoid Arthritis: A Systematic Review and Meta-analysis.

Mohammad Zamani, Shaghayegh Alizadeh-Tabari, Puja Chitkara, Siddharth Singh, Rohit Loomba

Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2023;21(11):2789-2796

PMID: 36871771

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Plain Language Summary

Non-alcoholic Fatty Liver Disease (NAFLD) is increasingly recognised as a comorbidity in patients with chronic inflammatory conditions, such as Rheumatoid Arthritis (RA). NAFLD is a condition defined as excess fat accumulation in the liver in individuals who consume little or no alcohol and do not have a secondary cause of hepatic steatosis. The aim of this study was to ascertain the pooled prevalence of NAFLD in RA patients and to identify any potential correlation between these two conditions. This study was a systematic review and meta-analysis that included observational studies from various databases, focusing on adult patients with RA and their diagnosis of NAFLD based on imaging or histologic assessment. The results of the meta-analysis found a pooled prevalence of NAFLD of 35.3%. Furthermore, the prevalence of NAFLD in men with RA was significantly higher than in women. Authors concluded that approximately one in three patients with RA may have NAFLD, and the prevalence is comparable to that in the general population. Thus, authors highlight the need for clinicians to actively screen for NAFLD in RA patients.

Abstract

BACKGROUND & AIMS

Previous studies have shown a potential association between nonalcoholic fatty liver disease (NAFLD) and some immune-mediated inflammatory diseases, such as rheumatoid arthritis (RA), but this association has not been analyzed systematically. Therefore, we aimed to perform a systematic review and meta-analysis to ascertain a pooled prevalence estimate of NAFLD among patients with RA to fill this gap in knowledge.

METHODS

We conducted a literature search in PubMed, Embase, Web of Science, Scopus, and ProQuest, for observational studies published from inception to August 31, 2022, which reported prevalence of NAFLD in 100 or more adult (age, ≥18 y) patients with RA. To be included, NAFLD diagnosis was based on either imaging or histologic assessment. The results were presented as pooled prevalence, odds ratio, and 95% CI. The I statistic was used to measure the heterogeneity between studies.

RESULTS

This systematic review included 9 eligible studies derived from 4 continents comprising 2178 patients (78.8% women) with RA. The pooled prevalence of NAFLD was 35.3% (95% CI, 19.9-50.6; I = 98.6%; P < .001) in patients with RA. All studies used ultrasound for the diagnosis of NAFLD, except for 1 study that used transient elastography. The pooled prevalence of NAFLD in men with RA was significantly higher than in women with RA (35.2%; 95% CI, 24.0-46.5 compared with 22.2%; 95% CI, 17.9-26.58; P for interaction = .048). Each 1-unit increase in body mass index was associated directly with a 24% increased risk of NAFLD in RA patients (adjusted odds ratio, 1.24; 95% CI, 1.17-1.31; I = 0.0%; P = .518).

CONCLUSIONS

Based on this meta-analysis, 1 in 3 patients with RA had NAFLD, which appears comparable with its overall prevalence among the general population. Clinicians should actively screen for NAFLD in patients with RA.

Published by Elsevier Inc.

Address: Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.; Center for Arthritis and Rheumatologic Excellence, Chula Vista, California.; Division of Gastroenterology, University of California San Diego, La Jolla, California; Division of Biomedical Informatics, University of California San Diego, La Jolla, California.; Nonalcoholic Fatty Liver Disease Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, California. Electronic address: [email protected].

DOI: 10.1016/j.cgh.2023.02.021