Screening for liver fibrosis in psoriatic arthritis: emphasizing metabolic risk

This editorial refers to the article ‘FIB-4 as an effective screening tool in psoriatic arthritis patients at high-risk for liver disease: a cross-sectional study using FibroScan’ by Katya Meridor et al. 2026; doi: 10.1093/rheumatology/keaf640. Metabolic dysfunction–associated steatotic liver disease (MASLD) is increasingly recognized as a significant comorbidity in patients with psoriasis and PsA [1, 2]. Despite its growing clinical relevance, MASLD remains difficult to detect in routine practice, as standard liver function tests (LFTs) often lack sufficient sensitivity, and imaging modalities such as ultrasound and FibroScan are not readily scalable for first-line screening [1]. In this context, the study by Meridor et al. [3] addresses an important unmet need by evaluating non-invasive tools for identifying clinically significant liver disease (CSLD) in high-risk PsA patients, defined as those with persistently abnormal LFTs and/or metabolic risk factors. In this single-centre, cross-sectional study, 89 patients with PsA referred for liver assessment were evaluated using commonly employed non-invasive fibrosis scores, including Fibrosis-4 (FIB-4) (age, AST, ALT and platelet count), BARD (BMI ≥28 kg/m2, AST/ALT ratio ≥0.8 and diabetes mellitus) and the Enhanced Liver Fibrosis (ELF) score (serum hyaluronic acid, procollagen III N-terminal peptide and tissue inhibitor of metalloproteinases-1) [3]. These scores were compared with imaging-based markers (liver stiffness >10 kPa on FibroScan or ultrasound features of MASLD) or histologic features consistent with MASLD when available.