Psoriatic arthritis: problems and solutions (case report)

DOI: 10.47026/2413-4864-2023-4-88-99

UDC: 616.72-002.77-08-02
BBC: 55.83

Zhuravleva N.V., Aksionova A.V., Yakupova S.P., Ivanova A.V., Smirnova T.L., Kupriyanov S.V.

Psoriatic arthritis: problems and solutions (case report)

Keywords: psoriatic arthritis, psoriasis, genetically engineered biological drugs, psoriasis severity and prevalence index, recommendations of the European League against Rheumatism

The purpose of this study is to evaluate the effectiveness of therapy for psoriatic arthritis with tumor necrosis factor inhibitor α–Adalimumab. Material and methods. Retrospective and prospective analyses of psoriatic arthritis course were performed in a patient along with a comprehensive examination before and after administering therapy with a tumor necrosis factor inhibitor α-Adalimumab. The diagnosis of the patient was made on the basis of psoriatic arthritis classification criteria, the assessment of psoriatic rashes was performed according to PASI index. The laboratory study included complete blood cell count and biochemical blood tests. The patient underwent X-ray examinations of the joints and magnetic resonance imaging of the lumbosacral spine in the STIR mode. Study results. The patient's first manifestations of psoriasis were detected at the age of 12 years. At the age of 22, the patient had pain in the lower back of VAS 2-3 points, as well as enthesites in the area of the lateral epicondyle of humerus, wings of the iliac bones, trochanter major, the upper edge of the patella and tibial tuberosity, the PASI index was 17.3 points. In order to relieve pain, the patient took non-steroidal anti-inflammatory drugs. Against the background of therapy with non-steroidal anti-inflammatory drugs, the intensity of pain in the lower back decreased, but enthesites persisted. At the age of 35, the patient was diagnosed with psoriatic arthritis, activity III, stage II, dactylitis, enthesites, PASI index 38.5 points; right-sided active sacroiliitis, ASDAS ESR index activity was 3.92 points, joint functional insufficiency of the 2^nd degree. Methotrexate therapy was prescribed. There was no positive dynamics against the background of treatment, in connection with this, therapy with genetically engineered biological drugs was initiated. We observed positive dynamics in the clinical course of psoriatic arthritis when Adalimumab was included in the treatment: after the 2^nd week of treatment, the articular syndrome subsided, joint pain decreased when evaluated on a scale of 2-3 points, the number of psoriatic plaques on the trunk and limbs decreased as well, the index of psoriatic rashes was 5.3 points. After 8 weeks from the start of therapy with Adalimumab, regression of pathological skin rashes was noted, the index of psoriatic rashes was 0 points. Conclusions. Therapy with Adalimumab in the patient resulted in regression of psoriatic manifestations on the skin, suppression of psoriatic arthritis activity. The study showed the clinical effectiveness of a genetically engineered biological drug – Adalimumab in achieving persistent clinical remission of psoriatic arthritis.

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About authors

Zhuravleva Nadezhda V.: Candidate of Medical Sciences, Associate Professor, Department of Internal Medicine , Chuvash State University, Russia, Cheboksary (zhuravlevanv@mail.ru; ORCID: https://orcid.org/0000-0001-6470-7724)

Aksionova Angelina V.: Doctor of Medical Sciences, Professor, Department of Faculty Therapy, N.I. Pirogov Russian National Research Medical University, Russia, Moscow (aksyonova-av@mail.ru; ORCID: https://orcid.org/0000-0002-4259-3807)

Yakupova Svetlana P.: Candidate of Medical Sciences, Associate Professor, Department of Hospital Therapy, Kazan State Medical University; Chief Freelance Rheumatologist, Ministry of Health of the Republic of Tatarstan, Russia, Kazan (yakupovaSP@mail.ru; ORCID: https://orcid.org/0000-0002-8590-4839)

Ivanova Anastasia V.: Chief Freelance Rheumatologist, Ministry of Health of the Chuvash Republic; Rheumatologist, Republican Clinical Hospital, Russia, Cheboksary (nastya_arh83@mail.ru; ORCID: https://orcid.org/0000-0002-0553-3135)

Smirnova Tatyana L.: Candidate of Medical Sciences, Associate Professor, Department
of Obstetrics and Gynecology, Chuvash State University, Russia, Cheboksary (tlsmr@mail.ru; ORCID: https://orcid.org/0000-0002-8224-1515)

Kupriyanov Sergey V.: Doctor of Medical Sciences, Professor, Head of the Department of Normal and Pathological Physiology, Chuvash State University, Russia, Cheboksary (kuper-SV@yandex.ru; ORCID: https://orcid.org/0000-0002-5272-7397)

Article link

Zhuravleva N.V., Aksionova A.V., Yakupova S.P., Ivanova A.V., Smirnova T.L., Kupriyanov S.V. Psoriatic arthritis: problems and solutions (case report) [Electronic resource] // Acta medica Eurasica. – 2023. – №4. P. 88-99. – URL: https://acta-medica-eurasica.ru/en/single/2023/4/9/. DOI: 10.47026/2413-4864-2023-4-88-99.

Single article

Zhuravleva N.V., Aksionova A.V., Yakupova S.P., Ivanova A.V., Smirnova T.L., Kupriyanov S.V.