A draft of the interdisciplinary guidelines for diagnosis, methods for assessment of the degree of inflammatory activity, therapeutic efficacy, and for the use of biological agents in patients with concomitant immunoinflammatory diseases (psoriasis, psoriatic arthritis, Crohn's disease)

РезюмеВ статье приводятся данные по некоторым заболеваниям кожи, часто встречающимся при воспалительных заболеваниях кишечника. Большинство данных заболеваний кожи напрямую связаны с активностью основного воспалительного процесса (узловатая эритема, гангренозная пиодермия, суппуративный гидраденит, синдром Свита), и основным методом их лечения будет являться снижение активности основного заболевания. При этом наличие у пациента с воспалительными заболеваниями кишечника кожных проявлений свидетельствует о наличии системной реакции организма и утяжеляет течение основного заболевания. У таких пациентов препараты, направленные на избирательное лечение воспалительного процесса в кишечнике (месалазины, ведолизумаб), как правило, будут являться неэффективными. Кроме того, пациенты с суппуративным гидраденитом и гангренозной пиодермией при тяжелом течении этих кожных проявлений будут нуждаться, помимо лечения основного заболевания, в местной терапии кожных проявлений болезни. С этой задачей гастроэнтеролог без помощи со стороны дерматолога, как правило, справиться не может. Также у пациентов с воспалительными заболеваниями кишечника часто встречаются поражения кожи, вызванные терапией этих заболеваний (парадоксальный псориаз, меланома). Парадоксальный псориаз возникает у пациентов с воспалительными заболеваниями кишечника на фоне терапии препаратами антиФНО и обычно может быть адекватно купирован местными средствами. В случае неэффективности местной терапии может рассматриваться вопрос о смене противорецидивной терапии воспалительных заболеваний кишечника с препаратов группы антиФНО на препараты группы антител к интерлейкинам 12, 23 (устекинумаб). Однако поражения кожи, не связанные с активностью воспалительных заболеваний кишечника или являющиеся осложнениями терапии, требуют мультидисциплинарного подхода с обязательным участием врачей-дерматологов.

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Skin diseases and inflammatory bowel diseases. Literature review

Alexandrov

Халиф

Khalif

et al. 2020

Medicinskij sovet

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Genetically engineered biologics to treat psoriasis. Experience with ustekinumab in an adolescent with severe psoriasis

Хобейш

Sokolovskiy

2023

Medicinskij sovet

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Modern pathogenetic therapy of psoriasis is the use of suppressive methods aimed to suppress immune reactions in the dermis, synovia, enthesis and eliminate the imbalance between anti-inflammatory and pro-inflammatory cytokines, chemokines. Today, genetically engineered biological drugs are one of the most promising pharmacotherapy achievements for the management of psoriasis, psoriatic arthritis in the group of immunosuppressive agents. Knowing the pathogenetic mechanisms that underlie the development of these diseases allows us today to highly selectively target the top key links of the immunopathogenetic cascade using genetically engineered biologicals, while barely affecting the protective factors of the patient’s immune system unlike the standard backbone (what is referred to as traditional) anti-inflammatory therapy. The treatment of psoriasis in children and adolescents practically involves the same drugs and methods as in adults. However, most of them are used in paediatric practice for conditions for which they are not clearly indicated, and studies on their efficacy and safety are still missing. Currently, it is possible to treat children and adolescents with genetically engineered biological drugs. Ustekinumab, etanercept, adalimumab, secukinumab, and ixekizumab are approved for use in moderate to severe psoriasis in the Russian Federation. In paediatric practice, the genetically engineered biological drug ustekinumab is one of the most effective, safe and convenient for the delivery of therapy (short induction cycle, rare infusions of the drug during maintenance therapy). The article describes the case study of the effective treatment of a 17-year-old patient with severe, continuously recurrent psoriasis. The targeted therapy, including the use of genetically engineered biological drugs, is increasingly being used to treat childhood psoriasis. Moreover, there are now more and more supporters among dermatologists who believe that genetically engineered biological drugs can be prescribed as the first-line drugs for the treatment of moderate to severe psoriasis in children and adolescents.

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Joint and spine damage in patients with inflammatory bowel diseases

Tarasova,

Shilova

2024

Medicinskij alfavit

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Damage to the joints and spine is a frequent extra-intestinal manifestation of inflammatory bowel diseases (IBD). Studies show a genetic and immunological link between joint damage and intestinal inflammation. Oligo- and polyarthritis of small and large joints, arthralgia, ankylosing spondylitis may develop. Arthritis in IBD is seronegative, characterized by non-erosive and non-destructive lesions. Articular syndrome is more often associated with a severe course of IBD and a large extent of the lesion. Arthritis with IBD, basically, debuts simultaneously with intestinal inflammation or occurs after, but may precede the development of IBD. Joint damage can make its debut with a detailed clinical picture, cases of latent course are also described, which complicates the timely diagnosis. The combination of joint syndrome and intestinal inflammation requires an interdisciplinary approach.

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A draft of the interdisciplinary guidelines for diagnosis, methods for assessment of the degree of inflammatory activity, therapeutic efficacy, and for the use of biological agents in patients with concomitant immunoinflammatory diseases (psoriasis, psoriatic arthritis, Crohn's disease)

Cited by 4 publications

References 36 publications

Skin diseases and inflammatory bowel diseases. Literature review

Skin diseases and inflammatory bowel diseases. Literature review

Genetically engineered biologics to treat psoriasis. Experience with ustekinumab in an adolescent with severe psoriasis

Joint and spine damage in patients with inflammatory bowel diseases

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