Cumulative methotrexate dose is not associated with liver fibrosis in patients with a history of moderate to severe psoriasis.

BACKGROUND: Liver fibrosis (LF) has established risk factors, but data on the impact of methotrexate on LF in psoriasis patients are lacking. This cross-sectional study aimed to determine the prevalence of LF in psoriasis patients and to evaluate the relationship between LF, cumulative methotrexate dose and other LF risk factors. METHODS: Adults with a history of moderate to severe chronic plaque psoriasis were recruited between June 2020 and March 2021. Patients underwent transient elastography to evaluate LF. Three values for liver stiffness measurement (LSM) were assessed, indicating mild or worse LF (≥7kPa), moderate or worse LF (≥7.9 kPa) and advanced LF (≥9.5kPa). Cumulative methotrexate dose and other potential risk factors for LF were assessed. RESULTS: 240 patients were recruited and 204 participants with valid LSM values were included in the analysis (median age 48 (IQR 37,57) years; 51% female; 56% Body Mass Index (BMI) ≥30 kg/m2 and median Alcohol Use Disorders Identification Test (AUDIT) score 4 (IQR 1,7, 23% score ≥ 8)). 91% had received methotrexate (median duration 36 months (IQR 14,78)). Prevalence of LF was 36%, 25% and 17 % using LSM ≥7kPa, ≥7.9 kPa and ≥9.5kPa respectively. There was no association between cumulative methotrexate dose (median 2.16 (IQR 0.93, 5.2) and continuous LSM values (unstandardised coefficient 0.16, (95% CI -0.49-0.82, p=0.626) or using the categorical LSM cut off values: ≥7kPa (unadjusted odds ratio 1.06 (95% CI 0.97-1.15), p= 0.192), ≥7.9 kPa (unadjusted odds ratio 1.03 (95% CI 0.94- 1.12), p= 0.577) and ≥9.5kPa (unadjusted odds ratio 1.01 (95% CI 0.91-1.12) p=0.843).The following risk factors were associated with higher LSM values: BMI (p=<0.001), Waist circumference (p=<0.001), metabolic syndrome (p=<0.001), AUDIT score (P=0.020), FIB-4 score (p= 0.03). BMI ≥28, diabetes and metabolic syndrome were shown to be better predictors of LF compared to Fib 4 score. CONCLUSION: This study confirms a high prevalence of significant LF in patients with psoriasis. Cumulative methotrexate dose was not associated with LF. Patients with BMI ≥28 kg/m2, metabolic syndrome and diabetes are at higher risk for LF. These risk factor may help to identify when a more detailed liver health assessment is needed.

Associations between early infections and childhood cognition in the Newcastle Thousand Families Study birth cohort.

Childhood infections have been shown to stunt growth, contribute to malnutrition and reduce cognition in early adulthood. This study aimed to assess relationships between early life infections and childhood cognition at age 11 years in the Newcastle Thousand Families Study (NTFS). The analysis included 741 members from the NTFS who had complete data for infections between birth and 5 years, and the 11-plus examinations. School records from the 11-plus examinations showed cognitive (IQ), English (EQ) and arithmetic (AQ) abilities. Housing conditions, overcrowding, birth order and social class were recorded at birth. Helicobacter pylori seropositivity was measured at age 49-51 years. Multivariable linear regression was used to examine relationships between infections and cognition. The total number of infections in the first 5 years of life was not significantly associated with IQ, EQ or AQ, nor were there significant relationships between cognitive outcomes and most infections. Tonsillitis did display a positive, significant association with IQ after adjustment for confounders (b = 6.43, 95% CI 0.92, 11.94, p = 0.022). Lower respiratory tract infections (LRTIs) showed significant negative relationships with all cognitive outcomes. H. pylori seropositivity at age 50 exhibited negative, significant relationships with EQ (p = 0.014) and AQ (p = 0.024) after adjustment for confounders. Although no significant relationship between overall infections and cognition were found, there were indications that LRTIs and gastrointestinal system infections may limit cognitive development. Given these infections remain prevalent, further research regarding severity and recurrence of infections and how they affect childhood cognition is needed.

Differences Between Self-Reported and Objectively Measured Hearing Loss at Age 61-63 Years: The Newcastle Thousand Families Birth Cohort.

PURPOSE: Hearing loss is most prevalent among older adults, yet underestimated by patients, clinicians, and research communities. This study aimed to assess the accuracy of self-reported hearing difficulties among a group of adults aged 61-63 years, against audiometric measures. METHOD: The analysis used a sample (N = 346) of the Newcastle Thousand Families Study birth cohort. Data from audiological examinations and self-reported hearing difficulties were used to compare subjective and objective hearing. Hearing aid use was also assessed. RESULTS: Over 40% of the participants had some level of hearing loss (n = 155, 44.8%), and 31% (n = 133) of these reported having hearing problems during subjective assessment. Only 18 (10%) of those with objectively measured hearing loss reported using hearing aids. CONCLUSIONS: There was an inconsistency between measured and self-perceived hearing loss among adults aged 61-63 years in this cohort. The small number of hearing aid users in the cohort is a concern, in that people in this age group appear not to be getting the help they need. The data also add to the research evidence that people at this age underestimate their hearing loss.