Psoriatic arthritis: pathogenetic features and innovative therapies

The paper considers the modern concepts of the etiology and pathogenesis of psoriatic arthritis (PsA). The latter is currently indicated as a T-cell-mediated disease that is based on the activation of cellular immunity, followed by the hyperproduction and imbalance of key pro- and anti-inflammatory cytokines, such as tumor necrosis factor-α (TNF- α), interleukin-1β (IL-1β), IL-6, IL-12/23, and IL-17. The paper presents the basic principles of diagnosis and clinical manifestations of the disease and notes the importance of screening questionnaires, the use of which allows specialists to diagnose PsA early, by actively identifying articular complaints, the characteristic clinical and radiological signs of damage to the joint, spine, and entheses. It is pointed out that the key target of pharmacotherapy for PsA is to achieve remission or minimal activity of the main clinical manifestations of the disease, to slow down or prevent its radiographic progression, to increase the length and quality of life in patients, and to reduce the risk of comorbidities. The authors characterize the major groups of used drugs: nonsteroidal anti-inflammatory drugs, conventional and targeted synthetic disease-modifying antirheumatic drugs, and biological drugs (inhibitors of TNF-α, IL-12/23, and IL-17). The key Treat-to-target principles of patient management are considered; it is noted that strict control over disease activity and treatment results provides suppression of all major clinical manifestations of PsA. The paper also shows the basic principles of the creation and further development of the All-Russian Registry of PsA patients, which makes it possible to optimize management decision-making on the provision of high-tech medical care and drugs for this cohort of patients.

psoriatic arthritis, enthesitis, dactylitis, cytokines, Treat-to-target (T2T) strategy, patient registry

1. Helliwell PS, Ruderman E. Natural history, prognosis, and Socioeconomic aspects of psoriatic arthritis. Rheum Dis Clin N Am. 2015;4:581-91. doi: 10.1016/j.rdc.2015.07.0041

2. Nystad TW, Husum YS, Furnes ON, et al. Incidence and predictive factors for orthopedic surgery in patients with psoriatic arthritis. J Rheumatol. 2018;45(11):1532-40. doi: 10.3899/jrheum.180203

3. Spelman L, Su JC, Fernandez-Penas P, et al. Frequency of undiagnosed psoriatic arthritis among psoriasis patients in Australian dermatology practice. J Eur Acad Dermatol Venereol. 2015;29:2184-91. doi: 10.1111/jdv.13210

4. Villani AP, Rouzaud M, Sevrain M, et al. Prevalence of undiagnosed psoriatic arthritis among psoriasis patients: systematic review and metaanalysis. J Am Acad Dermatol. 2015;73:242-8. doi: 10.1016/j.jaad.2015.05.001

5. Чамурлиева МН, Логинова ЕЮ, Коротаева ТВ, Баткаев ЭА. Поражение костно-суставного аппарата у больных псориазом по данным скринингового опросника PEST (Psoriasis Epydemiology Screening Tool) и ревматологического клинико-инструментального обследования. Научно-практическая ревматология. 2014;52(6):636-42 [Chamurlieva MN, Loginova EYu, Korotaeva TV, Batkaev EA. Osteoarticular injury in psoriatic patients according to the data of PEST (Psoriasis Epidemiology Screening Tool) questionnaire and rheumatological clinicoinstrumental examination. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2014;52(6):636-42 (In Russ.)]. doi: 10.14412/1995-4484-2014-636-642

6. Veale DJ, Fearon U, Eder L, et al. The incidence and risk factors for psoriatic arthritis in patients with psoriasis: a prospective cohort study. Arthritis Rheum. 2016;68:915-23. doi: 10.1002/art.39494

7. Eder L, Polachek A, Rosen Ch, et al. The development of psoriatic Arthritis in Patients With Psoriasis Is Preceded by a Period of Nonspecific Musculoskeletal Symptoms. A Prospective Cohort Study. Arthritis Rheum. 2017;69(3):622-9. doi: 10.1002/art.39973

8. Lewinson RT, Vallerand IA, Lowerison MW, et al. Depression is associated with an increased risk of psoriatic arthritis among patients with psoriasis: a population-based study. J Invest Dermatol. 2017;137(4):828-35. doi: 10.1016.j.jid2016.11.032

9. Thorarensen SM, Lu N, Ogdie A, et al. Physical trauma in primary care is associated with the onset of psoriatic arthritis among patients with psoriasis. Ann Rheum Dis. 2017;76(3):521-5. doi: 10.1136/annrheumdis-2016-209334

10. Theander E, Husmark T, Alenius GM, et al. Early psoriatic arthritis: short symptom duration, male gender and preserved physical functioning at presentation predict favourable outcome at 5-year follow-up. Results from the Swedish Early Psoriatic Arthritis Register (SwePsA). Ann Rheum Dis. 2013;73(2):407-13. doi: 10.1136/annrheumdis-2012-201972

11. Alamanos Y, Voulgari PV, Drosos AA. Incidence and prevalence of psoriatic arthritis: a systematic review. J Rheumatol. 2008;35(7):1354-8.

12. Баткаева НН, Коротаева ТВ, Баткаев ЭА. Разнообразие коморбидной патологии у больных псориазом тяжелого течения. Альманах клинической медицины. 2018;1(46):76-81 [Batkaeva NN, Korotaeva TV, Batkaev EA. A variety of comorbid pathology in patients with severe psoriasis. Al'manakh Klinicheskoi Meditsiny. 2018;1(46):76-81 (In Russ.)]. doi: 10.18786/2072-0505-2018-46-1-76-81

13. Michelsen B, Fiane R, Diamantopoulos AP, et al. A comparison of disease burden in rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis. PLoS One. 2015;10(4):e0123582. doi: 10.1371/journal.pone.0123582

14. Tillett W, Shaddick G, Askari A, et al. Factors influencing work disability in psoriatic arthritis: first results from a large UK multicentre study. Rheumatology (Oxford). 2015;54:157-62. doi: 10.1093/rheumatology/keu264

15. Peluso R, Iervolino S, Vitiello M, et al. Extra-articular manifestations in psoriatic arthritispatients. Clin Rheumatol. 2015;34(4):745-53. doi: 10.1007/s10067-014-2652-9

16. Ogdie A, Schwartzman S, Husni ME. Recognizing and managing comorbidities in psoriatic arthritis. Curr Opin Rheumatol. 2015;27:118-26. doi: 10.1097/BOR.0000000000000152

17. Haroon M, Gallagher P, Heffernan E, et al. High prevalence of metabolic syndrome and of insulin resistance in psoriatic arthritis is associated with the severity of underlying disease. J Rheumatol. 2014;41(7):1357-65. doi: 10.3899/jrheum.140021

18. Roubille C, Richer V, Starnino T, et al. Evidence-based recommendations for the management of comorbidities in rheumatoid arthritis, psoriasis, and psoriatic arthritis: expert opinion of the Canadian Dermatology-Rheumatology Comorbidity Initiative. J Rheumatol. 2015;42:1767-80. doi: 10.3899/jrheum.141112

19. Маркелова ЕИ, Коротаева ТВ, Новикова ДС и др. Распространенность метаболического синдрома у больных псориатическим артритом: его связь с воспалением и субклиническим атеросклерозом. Научно-практическая ревматология. 2016;54(Прил. 1):20-8 [Markelova EI, Korotaeva TV, Novikova DS, et al. Prevalence of metabolic syndrome in patients with psoriatic arthritis: Its association with inflammation and subclinical atherosclerosis. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2016;54(Suppl. 1):20-4 (In Russ.)]. doi: 10.14412/1995-4484-2016-1S-20-24

20. Skov L, Thomsen SF, Kristensen LE, et al. Cause-specific mortality in patients with psoriasis and psoriatic arthritis. Br J Dermatol. 2018 Jun 2018. doi: 10.1111/bjd.16919

21. Ritchlin CT, Colbert RA, Gladman DD. Psoriatic Arthritis N Engl J Med. 2017;376:957-70. doi: 10.1056/NEJMra1505557

22. Veale DJ, Fearon U. The pathogenesis of psoriatic arthritis. Lancet. 2018;391(10136):2273-84. doi: 10.1016/S0140-6736(18)30830-4

23. Barnas JL, Ritchlin CT. Etiology and Pathogenesis of Psoriatic Arthritis. Rheum Dis Clin North Am. 2015;41(4):643-63. doi: 10.1016/j.rdc.2015.07.006

24. FitzGerald O, Haroon M, Giles JT, Winchester R. Concepts of pathogenesis in psoriatic arthritis: genotype determines clinical phenotype. Arthritis Res Ther. 2015;17(1):115. doi: 10.1186/s13075-015-0640-3

25. Насонов ЕЛ. Новые возможности фармакотерапии иммуновоспалительных ревматических заболеваний: фокус на ингибиторы интерлейкина 17. Научно-практическая ревматология. 2017;55(1):68-86 [Nasonov EL. New possibilities of pharmacotherapy for immunoinflammatory rheumatic diseases: A focus on inhibitors of interleukin-17. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2017;55(1):68-86 (In Russ.)]. doi: 10.14412/1995-4484-2017-68-86

26. Batliwalla FM, Li W, Ritchlin CT, et al. Microarray analyses of peripheral blood cells identifies unique gene expression signature in psoriatic arthritis. Mol Med. 2005 Jan-Dec;11(1-12):21-9. doi: 10.2119/2006-00003

27. Jadon DR, Nightingale AL, McHugh NJ, et al. Serum soluble bone turnover biomarkers in psoriatic arthritis and psoriatic spondyloarthropathy. J Rheumatol. 2015 Jan;42(1):21-30. doi: 10.3899/jrheum.140223

28. Croes M, Oner FC, van Neerven D, et al. Proinflammatory T cells and IL-17 stimulate osteblast differention. Bone. 2016 Mar;84:262-70. doi: 10.1016/j.bone.2016.01.010

29. Sherlock JP, Joyce-Shaikh B, Turner SP, et al. IL-23 induces spondyloarthropathy by acting on ROR-gammat+ CD3+CD4-CD8-entheseal resident T cells. Nat Med. 2012 Jul 1;18(7):1069-76. doi: 10.1038/nm.2817

30. Gonzalez-Alvaro I, Ortiz AM, Alvaro-Gracia JM, et al. Interleukin 15 levels in serum may predict a severe disease course in patients with early arthritis. PLoS One. 2011;6(12):e29492. doi: 10.1371/journal.pone.0029492

31. Alenius GM, Eriksson C, Rantapaa Dahlqvist S. Interleukin-6 and soluble interleukin-2 receptor alpha markers of inflammation in patients with psoriatic arthritis? Clin Exp Rheumatol. 2009;27:120-3.

32. Коротаева ТВ. Ангиогенез при псориазе и псориатическом артрите: клеточные и гуморальные механизмы, роль в патогенезе и поиск перспективных мишеней терапии. Обзор. Современная ревматология. 2014;8(2):71-5 [Korotaeva TV. Angiogenesis in patients with psoriasis and psoriatic arthritis: cell-mediated and humoral mechanisms, its role in pathogenesis, and searching for promising therapeutic targets. Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2014;8(2):71-5 (In Russ.)]. doi: 10.14412/1996-7012-2014-2-71-75

33. Akhavani MA, Madden L, Buysschaert I, et al. Hypoxia upregulates angiogenesis and synovial cell migration in rheumatoid arthritis. Arthritis Res Ther. 2009;11(3):R64. doi: 10.1186/ar2689

34. Takayanagi H. Osteoimmunology and the effects of the immune system on bone. Nat Rev Rheumatol. 2009;5(12):667-76. doi: 10.1038/nrrheum.2009.217

35. Gladman DD, Antoni C, Mease P, et al. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis. 2005;64 Suppl 2:14-7. doi: 10.1136/ard.2004.032482

36. Lubrano E, Parsons WJ, Marchesoni A, et al. The Definition and Measurement of Axial PsoriaticArthritis. J Rheumatol. 2015;93 Suppl:40-2.

37. Губарь ЕЕ, Логинова ЕЮ, Смирнов АВ и др. Клинико-инструментальная характеристика аксиального поражения при раннем периферическом псориатическом артрите. (Данные исследования РЕМАРКА). Научно-практическая ревматология. 2018;56(1):34-40 [Gubar EE, Loginova EYu, Smirnov AV, et al. Clinical and instrumental characteristics of axial lesion in early peripheral psoriatic arthritis (data of a REMARCA study). Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2018;56(1):34-40 (In Russ.)]. doi: 10.14412/1995-4484-2018-1-34-40

38. Логинова ЕЮ, Коротаева ТВ, Смирнов АВ и др. Особенности поражения осевого скелета при раннем псориатическом артрите (исследование РЕМАРКА). Научно-практическая ревматология. 2016;54(Прил. 1):15-9 [Loginova EYu, Korotaeva TV, Smirnov AV, et al. Specific features of axial skeletal involvement in early psoriatic arthritis (The REMARCA Trial). Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2016;54(Suppl. 1):15-19 (In Russ.)]. doi: 10.14412/1995-4484-2016-1S-15-19

39. Коротаева ТВ, Корсакова ЮЛ. Псориатический артрит: классификация, клиническая картина, диагностика, лечение. Научно-практическая ревматология. 2018;56(1):60-9 [Korotaeva TV, Korsakova YuL. Psoriatic arthritis: classification, clinical presentation, diagnosis, treatment. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2018;56(1):60-9 (In Russ.)]. doi: 10.14412/1995-4484-2018-1-60-69

40. Haroon M, Kirby B, FitzGerald O. High prevalence of psoriatic arthritis in patients with severe psoriasis with suboptimal performance of screening questionnaires. Ann Rheum Dis. 2013;72:736-40. doi: 10.1136/annrheumdis-2012-201706

41. Reich K, Kruger K, Mossner R, et al. Epidemiology and clinical pattern of psoriatic arthritis in Germany: a prospective interdisciplinary epidemiological study of 1511 patients with plaque-type psoriasis. Br J Dermatol. 2009;160:1040-7. doi: 10.1111/j.1365-2133.2008.09023.x

42. Taurog JD, Chhabra A, Colbert RA. Ankylosing spondylitis and axial spondyloarthritis. N Engl J Med. 2016;374:2563-74. doi: 10.1056/NEJMra1406182

43. Geijer M, Lindqvist U, Husmark T, et al. The Swedish early psoriatic arthritis registry 5-year followup: substantial radiographic progression mainly in men with high disease activity and development of dactylitis. J Rheumatol. 2015 Nov;42(11):2110-7. doi: 10.3899/jrheum.150165. Epub 2015 Oct 15.

44. Olivieri I, Salvarani C, Cantini F, et al. Fast spin echo-T2-weighted sequences with fat saturation in dactylitis of spondylarthritis: No evidence of entheseal involvement of the flexor digitorum tendons. Arthritis Rheum. 2002;46(11):2964-7. doi: 10.1002/art.10633

45. Mease PJ, Karki C, Palmer JB, et al. Clinical characteristics, disease activity and patient-reported outcomes in psoriatic arthritis patients with dactylitis or enthesitis: results from the Corrona psoriatic arthritis/Spondyloarthritis registry. Arthritis Care Res (Hoboken). 2017 Nov;69(11):1692-9. doi: 10.1002/acr.23249

46. Kehl AS, Corr M, Weisman MH. Review: enthesitis: new insights into pathogenesis, diagnostic modalities, and treatment. Arthritis Rheum. 2016;68:312-22. doi: 10.1002/art.39458

47. Tinazzi I, Adami S, Zanolin EM, et al. The early psoriatic arthritis screening questionnaire: a simple and fast method for the identification of arthritis in patients with psoriasis. Rheumatology (Oxford). 2012;51:2058-63. doi: 10.1093/rheumatology/kes187

48. Maejima H, Katayama C, Taniguchi T, et al. Japanese version of the early psoriatic arthritis screening questionnaire (EARP). Int J Dermatol. 2016;43:385-8. doi: 10.1111/1346-8138.13092

49. Salaffi F, Di Carlo M, Bugatti L, et al. Development and pilottesting of a new tool to screen psoriasis patients for the presence of psoriatic arthritis: the simple psoriatic arthritis screening (SiPAS) questionnaire. J Eur Acad Dermatol Venereol. 2017;31:e167-9. doi: 10.1111/jdv.13902

50. Mishra S, Kancharla H, Dogra S, Sharma A. Comparison of four validated psoriatic arthritis screening tools in diagnosing psoriatic arthritis in patients with psoriasis (COMPAQ Study). Br J Dermatol. 2017;176:765-70. doi: 10.1111/bjd.14929

51. Ibrahim GH, Buch MH, Lawson C, et al Evaluation of an existing screening tool for psoriatic arthritis in people with psoriasis and the development of a new instrument: the Psoriasis Epidemiology Screening Tool (PEST) questionnaire. Clin Exper Rheumatol. 2009;27:469-74.

52. Абдулганиева ДИ, Бакулев АЛ, Белоусова ЕА и др. Проект междисциплинарных рекомендаций по диагностике, методам оценки степени активности, терапевтической эффективности и применению генно-инженерных биологических препаратов у пациентов с сочетанными иммуновоспалительными заболеваниями (псориаз, псориатический артрит, болезнь Крона). Современная ревматология. 2018;12(3):4-18 [Abdulganieva DI, Bakulev AL, Belousova EA, et al. Draft interdisciplinary guidelines for diagnosis, methods for estimation of the degree of activity, for evaluation of therapeutic efficacy and for use of biological agents in patients with concomitant immunoinflammatory diseases (psoriasis, psoriatic arthritis, Crohn's disease). Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2018;12(3):4-18 (In Russ.)]. doi: 10/14412/1996-7012-2018-3-4-18

53. Клинические рекомендации «Псориатический артрит», утвержденные Российским обществом дерматовенерологов и косметологов на XVI Всероссийском Съезде дерматовенерологов и косметологов (г. Москва, 16 июня 2016 г.) и профильной комиссией Экспертного совета МЗ РФ по специальности «Ревматология» (протокол №12 от 21 марта 2016 г.) [Clinical recommendations «Psoriatic arthritis », approved by the Russian Society of Dermatovenerologists and Cosmetologists at the XVI All-Russian Congress of Dermatovenerologists and Cosmetologists (Moscow, June 16, 2016) and the profile commission of the Expert Council of the Ministry of Health of the Russian Federation in the specialty «Rheumatology» (protocol No. 12 of March 21, 2016)]. Доступно по ссылке: http://cr.rosminzdrav.ru/schema.html (Дата обращения 09.07.2016).

54. Коротаева ТВ, Зоткин ЕГ, Несмеянова ОБ и др. Применение ингибитора интерлейкина 17-А секукинумаба при псориатическом артрите. Субанализ российской популяции международных рандомизированных клинических исследований FUTURE 1 и FUTURE 2. Научно-практическая ревматология. 2017;55(2):151-9 [Korotaeva TV, Zotkin EG, Nesmeyanova OB, et al. Use of the interleukin-17A inhibitor secukinumab in psoriatic arthritis: A subanalysis of the Russian population in the international randomized clinical trials FUTURE 1 and FUTURE 2. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2017;55(2):151-8 (In Russ.)]. doi: 10.14412/1995-4484-2017-151-158

55. Gossec L, Smolen JS, Ramiro S, et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann Rheum Dis. 2016;75:499-510. doi: 10.1136/annrheumdis-2015-208337

56. Coates LC, Moverley AR, McParland L, et al. Effect of tight control inflammation in early psoriatic arthritis (TICOPA): a UK multicenter, open-label, randomized controlled trial. Lancet. 2015;386:2489-98. doi: 10.1016/S0140-6736(15)00347-5

57. Coates LC, Helliwell PS. Methotrexate efficacy in the Tight Control in Psoriatic Arthritis (TICOPA) study. J Rheumatol. 2016;43(2):356-61. doi: 10.3899/jrheum.150614

58. Коротаева ТВ, Логинова ЕЮ, Гетия ТС, Насонов ЕЛ. Результаты применения стратегии «Лечение до достижения цели» у больных ранним псориатическим артритом через 1 год после начала терапии: данные исследования РЕМАРКА. Терапевтический архив. 2018;90(5):22-9 [Korotaeva TV, Loginova EYu, Getiya TS, Nasonov EL. Results of one-year treatto-target strategy in early psoriatic arthritis: data of an open-label REMARCA study. Terapevticheskii Arkhiv. 2018;90(5):22-9 (In Russ.)]. doi: 10.26442/terarkh201890522-29

59. Van den Bosch F, Coates L. Psoriatic arthritis 2 Clinical management of psoriatic arthritis. Lancet. 2018 Jun 2;391(10136):2285-94. doi: 10.1016/S0140-6736(18)30949-8

60. McInnes IB, Sieper J, Braun J, et al. Efficacy and safety of secukinumab, a fully human anti-interleukin-17A monoclonal antibody, in patients with moderate-to-severe psoriatic arthritis: a 24-week, randomised, double-blind, placebo-controlled, phase II proof-ofconcept trial. Ann Rheum Dis. 2014;73:349-56. doi: 10.1136/annrheumdis-2012-202646

61. Zisapel M, Zisman D, Madar-Balakirski N, et al. Prevalence of TNF-α blocker immunogenicity in psoriatic arthritis. J Rheumatol. 2015:42(1):73-8. doi: 10.3899/jrheum.140685

62. Cutolo M, Myerson G, Fleischmann R. Long-term (52-week) results of a phase 3, randomized, controlled trial of apremilast, an oral phosphodiesterase 4 inhibitor, in patients with psoriatic aethritis (PALACE 2) [abstract]. Arthritis Rheum. 2013;65 Suppl:346e347.

63. Edwards C, Blanco F. Long-term (52-week) results of a phase 3, randomized, controlled trial of apremilast, an oral phosphodiesterase 4 inhibitor, in patients with psoriatic arthritis and current skin involvement (PALACE 3) [abstract]. Arthritis Rheum. 2013;65 Suppl:132.

64. Корсакова ЮЛ, Коротаева ТВ. Апремиласт: обновленные данные об эффективности и безопасности при длительном лечении больных псориатическим артритом. Научно-практическая ревматология. 2018;56(5):649-54 [Korsakova YuL, Korotaeva TV. Apremilast: an update on its efficacy and safety during long-term treatment of patients with psoriatic arthritis. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2018;56(5):649-54 (In Russ.)]. doi: 10.14412/1995-4484-2018-649-654

65. Mease P, Hall S, FitzGerald O, et al. Tofacitinib or adalimumab versus placebo for psoriatic arthritis. N Engl J Med. 2017;377:1537-50. doi: 10.1056/NEJMoa1615975

66. Papp KA, Menter MA, Abe M, et al. Tofacitinib, an oral Janus kinase inhibitor, for the treatment of chronic plaque psoriasis: results from two randomized, placebocontrolled, phase III trials. Br J Dermatol. 2015;173:949-61. doi: 10.1111/bjd.14018

67. Ritchlin C, Rahman P, Kavanaugh A, et al. Efficacy and safety of the anti-IL-12/23 p40 monoclonal antibody, ustekinumab, in patients with active psoriatic arthritis despite conventional nonbiological and biological anti-tumour necrosis factor therapy: 6-month and 1-year results of the phase 3, multicentre, doubleblind, placebocontrolled, randomised PSUMMIT 2 trial. Ann Rheum Dis. 2014;73:990-9. doi: 10.1136/annrheumdis-2013-204655

68. Gladman DD, Rigby W, Azevedo VF, et al. Tofacitinib for Psoriatic Arthritis in Patients with an Inadequate Response to TNF Inhibitors. N Engl J Med. 2017;377:1525-36. doi: 10.1056/NEJMoa1615977

69. Smolen J, Schols M, Braun J, et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis. 2017;0:1-15.

70. Логинова ЕЮ, Коротаева ТВ, Смирнов АВ и др. Достижение минимальной активности болезни и динамика рентгенологических изменений при раннем псориатическом артрите через год лечения в рамках стратегии «Лечение до достижения цели» (предварительные результаты исследования РЕМАРКА). Научно-практическая ревматология. 2017;55(6):610-5 [Loginova EYu, Korotaeva TV, Smirnov AV, et al. Achievement of minimal disease activity and progression of radiographic changes in early psoriatic arthritis one year after initiation of treatment in «Treat to target» strategy (preliminary results of the REMARKA study). Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2017;55(6):610-5 (In Russ.)]. doi: 10.14412/1995-4484-2017-610-615.