Medical and social care program for patients with psoriasis and/or psoriatic arthritis eligible for biological dmards in real clinical practice

High prevalence in different age groups, a significant decrease in patient’s quality of life, and potentially unfavorable outcomes, especially in association with comorbid pathologies define the medico-social significance of psoriasis. The article analyzes the clinical and anamnestic data obtained within the program of medical and social support of patients with psoriasis (PsO) and / or high-to-moderate severity psoriatic arthritis (PsA) “Take control of psoriasis”, launched by ROOI “Human Health” in the conjunction with the Interregional Charitable Public Organization “Skin and Allergic Diseases”. The study involved 20 physicians (8 dermatologists and 12 rheumatologists) from 11 cities and regions of Russia. The program lasted for 3 months and included one-time epidemiologic data collection of 564 patients and educational sessions, aimed to inform patients about their disease features, risk factors, and current international approaches to diagnostics. Every third patient demonstrated the features of both – psoriatic arthritis and psoriasis, established by two specialties – dermatologists and rheumatologists co-existing PsO+PsA in the majority of patients (94%). Patients with various forms of PsO and PsA had comorbid conditions, with prevailing cardiovascular, endocrine and metabolic disorders. Cardiovascular diseases prevailed in the structure of comorbid pathology showing 44% incidence, followed by endocrine disorders (metabolic syndrome, diabetes mellitus) diagnosed in 23% sometimes associated with other diseases in a proportion of patients; 37% patients were overweight or obese based on BMI, especially those receiving biologics. 58% and 49% of patients in the age group of 45–59 years received biologic therapy under the supervision of dermatologists and rheumatologists, respectively. In contrast, patients aged 18–44 years were more likely to be on biologic therapy administered by a rheumatologist – 43%, with only 27% treated by dermatologists. Among all patients on biologic therapy dermatological patients’ mean age was 47.95 years and rheumatological – 40.84 years. Therapy with biologics made it possible to achieve PASI 75 in PsO and minimal disease activity in PsA significantly more often (in 95% and 72% of patients) than therapy with conventional DMARDs / tsDMARD (in 43% and 27%) and other types of therapy (in 64% and 14%, respectively).

psoriasis, psoriatic arthritis, comorbidity, biological genetic engineering therapy

1. Boehncke W.H., Schön M.P. Psoriasis. Lancet. 2015;386(9997):983–994. DOI: 10.1016/S0140-6736(14)61909-7

2. Korman N.J. Management of psoriasis as a systemic disease: what is the evidence? British J Dermatol. 2020;182:840–848. DOI: 10.1111/bjd.18245

3. Polikarpov A.V., Alexandrova G.A., Golubev N.A., et al. The incidence of the entire population of Russia in 2017. Statistical materials. Part 1. Moscow; 2018:140 (In Russ.). DOI: https://doi.org/10.25208/0042-4609-2019-95-2-15-28

4. Gisondi P., Altomare G., Ayala F., et al. Italian guidelines on the systemic treatments of moderate-to-severe plaque psoriasis. J Eur Acad Dermatol Venereol. 2017;31(5):774–790. DOI: 10.1111/jdv.14114

5. Armstrong A.W., Schupp C., Wu J., et al. Quality of Life and Work Productivity Impairment among Psoriasis Patients: Findings from the National Psoriasis Foundation Survey Data 2003–2011. PLOS ONE. 2012;7(12):e52935. DOI: 10.1371/journal.pone.0052935

6. Alinaghi F., Calov M., Kristensen L., et al. Prevalence of psoriatic arthritis in patients with psoriasis: a systematic review and meta-analysis of observational and clinical studies. J Am Acad Dermatol. 2019;80(1):251–265.e19. DOI: 10.1016/jaad.2018.06.027

7. Nasonov E.L., Korotaeva T.V., Lila A.M., Kubanov A.A. Can the development of psoriatic arthritis be prevented in patients with psoriasis? Nauchnoprakticheskaya revmatologiya = Rheumatology Science and Practice. 2019;57(3):250–254 (In Russ.). DOI: 10.14412/1995-4484-2019-250-254

8. Ritchlin C.T., Colbert R.A., Gladman D.D. Psoriatic Arthritis. N Engl J Med. 2017;376(10):957–970. DOI: 10.1056/NEJMra1505557. Erratum in: N Engl J Med. 2017;376(21):2097.

9. Stiff K.M., Glines K.R., Porter C.L., Cline A., Feldman S.R. Current pharmacological treatment guidelines for psoriasis and psoriatic arthritis. Expert Rev Clin Pharmacol. 2018;11(12):1209–1218. DOI: 10.1080/17512433.2018.1548277. Epub 2018.

10. Armstrong A.W., Read C. Pathophysiology, Clinical Presentation, and Treatment of Psoriasis: A Review. JAMA. 2020;323(19):19451960. DOI: 10.1001/jama.2020.4006. PMID: 32427307

11. Menter A., Strober B.E., Kaplan D.H., et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019;80(4):1029–1072. DOI: 10.1016/j.jaad.2018.11.057

12. Singh J.A., Guyatt G., Ogdie A., et al. Special Article: 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis. Arthritis Care Res (Hoboken). 2019;71(1):2–29. DOI: 10.1002/acr.23789

13. Russian clinical guidelines. Rheumatology. Ed. E.L. Nasonov. Moscow: GEOTAR-Media, 2020 (In Russ.).

14. Scher J.U., Ogdie A., Merola J.F., et al. Preventing psoriatic arthritis: focusing on patients with psoriasis at increased risk of transition. Nature reviews. Rheumatol. 2019;15:153–163. DOI: 10.1038/s41584-019-0175-0

15. Zabotti A., Tinazzi I., Aydin S.Z., McGonagle D. From Psoriasis to Psoriatic Arthritis: Insights from Imaging on the Transition to Psoriatic Arthritis and Implications for Arthritis Prevention. Curr Rheumatol Rep. 2020;22(6):24. DOI: 10.1007/s11926-020-00891-x

16. Van den Reek J., Seyger M., van Lumig P., et al. The journey of adult psoriasis patients towards biologics: past and present Results from the BioCAPTURE registry. J Eur Acad Dermatol Venereol. 2018;32(4):615–623. DOI: 10.1111/jdv.14684