Sonographic evidence of hepatic steatosis and elevated liver enzymes are commonly used as non-invasive surrogate markers for the diagnosis of NAFLD but liver biopsy remained the gold standard diagnostic tool.26–28 PsA patients, particularly those with severe disease exhibit elevated levels of cytokines such as tumour necrosis factor alpha (TNF-a) and interleukin-6 (IL-6) which have been implicated in the development and progression of NAFLD. This evidence concerns the gene TNF and metabolic dysfunction-associated steatotic liver disease.