Patients with primary sclerosing cholangitis (PSC) who also have metabolic dysfunction-associated steatotic liver disease (MASLD) experience significantly more intense itching, or pruritus, but surprisingly report lower levels of fatigue, according to a new study published in the Journal of Clinical Medicine.
The research, a single-center analysis of 103 PSC patients treated between 2018 and 2024, found that roughly one-third of those studied also had MASLD, defined as the presence of hepatic steatosis – fat in the liver – alongside at least one cardiometabolic risk factor. Patients with both conditions tended to be older and have a higher body mass index than those with PSC alone. The study also noted a greater prevalence of small bile duct involvement in the group with MASLD overlap.
Researchers utilized validated instruments to assess patient-reported fatigue and pruritus levels. Statistical modeling revealed that patients with MASLD overlap had more than threefold higher odds of experiencing greater pruritus intensity compared to those without MASLD. Conversely, the presence of MASLD was associated with approximately two-thirds lower odds of reporting high fatigue intensity.
The findings suggest that the coexistence of metabolic steatosis may influence the symptom burden experienced by PSC patients in ways not fully explained by traditional understanding of cholestatic liver disease. The unexpected reduction in fatigue levels among those with MASLD overlap challenges existing assumptions about symptom patterns in patients with overlapping liver conditions and points to potentially unrecognised biological mechanisms, possibly involving metabolic or inflammatory pathways.
PSC is a chronic, progressive disease characterized by inflammation and scarring of the bile ducts, ultimately leading to liver damage. The American Association for the Study of Liver Diseases (AASLD) regularly publishes practice guidelines for the diagnosis and treatment of PSC and related conditions, including cholangiocarcinoma, a cancer of the bile ducts. These guidelines are developed by panels of experts, including hepatologists, and aim to provide evidence-based recommendations for patient care.
The study authors recommend that clinicians consider routinely assessing for steatosis and monitoring symptoms like pruritus and fatigue in PSC patients, given the high prevalence of MASLD in populations with metabolic risk factors. Further research is needed to elucidate the underlying mechanisms driving these symptom differences and to determine whether they necessitate distinct management strategies.
