Predictors of psoriatic arthritis development in psoriasis patients: The role of biological therapy in the pathological process

This article is dedicated to the risk factors for psoriatic arthritis development in psoriasis patients, as well as current biotherapeutic options for moderate to severe course of psoriasis and psoriatic arthritis in the absence of response to traditional therapy. The etiology and pathogenetic mechanisms of psoriasis and psoriatic arthritis are considered in the analytical part of the article. The disease is widespread and affects up to 11% of the world's population. One of the most common and severe comorbid conditions is psoriatic arthritis (PsA), which develops in one third of patients with psoriasis. PsA is a chronic potentially severe inflammatory disease of the musculoskeletal system characterized by such clinical manifestations as damage to the axial (spondylitis, sacroiliitis) and peripheral joints (arthritis, dactyl), enthesitis, accompanied by psoriatic skin rashes and onychodystrophy. The disease can develop both before and after the manifestation of skin manifestations. PsA is a disease with a progressive course that can lead to disability and the development of irreversible changes, therefore it requires timely diagnosis, taking into account risk factors and preclinical manifestations, the appointment of effective treatment, and an interdisciplinary approach to therapy. Modern drugs used in the treatment of PsA are aimed at reducing inflammation, maintaining control over the disease and should inhibit destructive processes in the joints, improving the quality of life of patients, meeting modern requirements for efficacy and safety, and not pose a heavy financial burden. The article presents two clinical observations of prescribing disease-modifying treatment to patients with psoriasis and a high risk of PsA and its subclinical manifestations. This article presents two clinical case reports on the treatments of long-lasting psoriasis vulgaris in men with a history of failure to respond to glucocorticosteroids (GCS) and cytostatics. They were prescribed systemic biologic drug therapy, which showed the expected results.