MASLD and ALD Significantly Raise Systemic Sclerosis Risk, Large-Scale Study Shows

"The study of over 4.4 million people found that metabolic dysfunction-associated liver disease (MASLD) increased the risk of systemic sclerosis (SSc) by 61%, while alcohol-related liver disease (ALD) tripled the risk," the researchers reported. "There was no significant link with combined metabolic and alcohol-related liver disease. The findings suggest that limiting alcohol intake may help reduce the risk of developing SSc."

The study analyzed health data from over 4.4 million individuals who participated in a national health screening program in 2012. Participants were tracked for an average of 9.2 years to investigate whether various types of SLD influenced the incidence of SSc, which is known to be associated with antinuclear antibody (ANA) positivity.

To explore this potential link, researchers classified participants into four groups: those without SLD, those with metabolic dysfunction-associated liver disease, those with combined metabolic dysfunction and alcohol-related liver disease (MetALD), and those with alcohol-related liver disease. Using multivariable Cox proportional hazard models, the team assessed the relative risk of developing SSc in each group.

Key Findings:

• Individuals with MASLD had a 61% higher risk of developing systemic sclerosis (SSc) compared to those without SLD (HR: 1.612).
• Those with ALD had a threefold increased risk of SSc (HR: 3.063).
• The MetALD group showed an elevated risk of SSc (HR: 1.575), but this was not statistically significant.

The study provides new insight into the systemic consequences of liver dysfunction, particularly with autoimmune diseases. The authors emphasized that the association between SLD and SSc is especially strong in cases involving alcohol-related liver damage. These findings highlight the importance of early detection and management of liver health, particularly through lifestyle interventions such as reducing alcohol consumption.

The results support the hypothesis that liver-related inflammation and metabolic disturbances may contribute to the pathogenesis of systemic sclerosis. Given the chronic and progressive nature of SLD and SSc, the study underscores the need for integrated care strategies that address both hepatic and autoimmune risk factors.

The authors concluded, "nationwide Korean study sheds light on a previously underexplored connection between steatotic liver disease and systemic sclerosis. The research calls for increased awareness among clinicians and public health authorities regarding the broader implications of liver disease and supports the promotion of liver health as a possible means to prevent autoimmune conditions like SSc."

Reference:

Kwon, O. C., Lee, K., & Han, K. Association between steatotic liver disease and risk of incident systemic sclerosis: A nationwide cohort study. Rheumatology. https://doi.org/10.1093/rheumatology/keaf278