Prevalence of nonalcoholic fatty liver disease in rheumatoid arthritis: An updated systematic review and meta-analysis.

BACKGROUND

Rheumatoid arthritis (RA) is a chronic autoimmune disorder associated with various comorbidities, including nonalcoholic fatty liver disease (NAFLD). The prevalence of NAFLD in RA patients remains inconsistently reported, necessitating a comprehensive meta-analysis to estimate its true prevalence. This study aimed to assess the prevalence of NAFLD in patients with RA by synthesizing data from multiple studies.

METHODS

A systematic search was performed across PubMed, Scopus, and Web of Science for studies published up to January 2025. Eligible studies that reported on the prevalence of NAFLD in RA patients were included. A random-effects model was applied, and sensitivity analyses were conducted to test the robustness of the findings. Statistical analyses were performed using Comprehensive Meta-Analysis Software (CMA) version 4.

RESULTS

The pooled prevalence of NAFLD/nonalcoholic steatohepatitis (NASH) in RA patients was found to be 22.8% (95% CI = 7.8%-50.8%) with substantial heterogeneity (I² = 99.52%). The prediction interval for the prevalence of NAFLD/NASH ranged from 1% to 99%. Subgroup analysis showed varying prevalence rates based on diagnostic modalities: 33.3% for FibroScan, 43.9% for liver biopsy, and 30.5% for ultrasonography.

CONCLUSION

The prevalence of NAFLD is remarkable in RA patients, with varying rates depending on diagnostic methods. The substantial heterogeneity observed across studies, reflected in the wide range of the prediction interval, underscores the need for further studies to provide a more precise estimate. Given the notable prevalence of NAFLD/NASH in RA patients, clinicians are suggested to consider this issue by implementing regular liver screening as a valuable part of RA patient care. More studies are essential to offer a clearer and more consistent understanding of NAFLD/NASH in this population.