Psoriasis and psoriatic arthritis (PA) are systemic immune-mediated inflammatory diseases, thus PA develops in one third of patients with skin manifestations. Early diagnosis of PA risks is crucial for prevention of disability and quality of life reduction. Modern approaches are focused on the identification of a «window of possibility» for initiation of therapy before irreversible changes in joints occur.

OBJECTIVE

To develop a predictive model for identification of patients with high risk for PA development and evaluate the efficacy of early treatment with IL-17A inhibitor — netakimab.

MATERIAL AND METHODS

The study included 100 patients with moderate/severe psoriasis without clinical signs of PA that did not meet the CASPAR criteria. The patients were divided into groups: one received netakimab, the other — standard systemic therapy. Clinical indices (PASI, NAPSI, DLQI), levels of biomarkers (CXCL10, MMP-3, YKL-40, calprotektin), joint MRI data were evaluated.

RESULTS

Onychodystrophy (93%), duration of psoriasis more than 7 years (98%), severe course (97%) were the most significant clinical risk factors for PA. Netakimab demonstrated high efficacy: by the 12th week 95.8% of patients had PASI 90, by the 52nd — 89.1% had PASI 100 After 5 years, PASI 100 remained in 70%. MRI showed regression of subclinical inflammation in 64% of patients. Levels of biomarkers decreased significantly after 3 months of therapy.

DISCUSSION

The data confirm the importance of comprehensive assessment of patient’s condition, including clinical, laboratory and imaging indicators. Early application of GEBD effectively prevents the development of PA in patients at risk.

CONCLUSION

Early intervention with GEBD in patients with severe psoriasis in combination with symptoms of subclinical PA significantly improves quality of life, prevents disability and reduces economic burden in the long term. The obtained results can be used to revise clinical guidelines and implement them in practical healthcare.