scholarly journals Successful use of the interleukin-17A inhibitor (ixekizumab) in the treatment of psoriatic arthritis

2020 ◽  
Vol 14 (4) ◽  
pp. 165-170
Author(s):  
A. M. Dadalova ◽  
E. A. Vasilenko ◽  
R. R. Samigullina ◽  
V. I. Mazurov
Keyword(s):  
Psoriatic Arthritis ◽  
Clinical Case ◽  
Clinical Manifestations ◽  
Biological Drugs ◽  
Average Decrease ◽  
Interleukin 17A ◽  
Urgent Task ◽  
Wide Range ◽  
Factor Α ◽  
New Treatments

Psoriatic arthritis (PsA) is a chronic immune-mediated disease from a group of spondyloarthritis, which is characterized by damage to the musculoskeletal system with a wide range of different clinical manifestations and is usually associated with psoriasis. Activation of the interleukin (IL) 23/IL17 axis plays a key role in the pathogenesis of PsA and psoriasis. When non-steroidal and synthetic disease-modifying antirheumatic drugs are insufficiently effective, biological drugs are recommended. In recent years, there have been considerable advances in PsA treatment with tumor necrosis factor-α (IFN-α) inhibitors and IL-12/23 inhibitors. However, in some cases, this therapy fails to provide the desired effect and a search for new treatments for PsA seems to be an urgent task. The paper desctibes a clinical case demonstrating the efficacy of the IL17A inhibitor ixekizumab in a patient with high PsA activity and recurrent uveitis in both eyes. Ixekizumab therapy resulted in positive changes as the reduced severity of articular syndrome and psoriasis and normalization of acute phase parameters. Assessing the activity of PsA over time when using ixekizumab during a year showed an average decrease in ESR from 72 to 19 mm/h, in CRP from 162.1 to 0 mg/L, BSA from 51 to 0.25%, PASI from 43. 6 to 0, DAPSA from 78.2 to 2, ASDAS-SRB from 5.11 to 1.12, BASDAI from 4.85 to 1, BASFI from 5.3 to 0.7, BASMI from 5.0 to 2.6, MASES from 6 to 0, LEI from 2 to 0, SPARCC from 6 to 0, and NAPSI from 28 to 8. Thus, this clinical case is an example of successful treatment with the IL17 inhibitor ixekizumab for PsA with recurrent uveitis in the patient who has previously received three drugs from the TNFα group without any effect.

scholarly journals Psoriatic arthritis: pathogenetic features and innovative therapies

2019 ◽  
Vol 56 (6) ◽  
pp. 685-691 ◽  
Author(s):  
A. M. Lila ◽  
E. L. Nasonov ◽  
T. V. Korotaeva
Keyword(s):  
Psoriatic Arthritis ◽  
Clinical Manifestations ◽  
Treat To Target ◽  
Management Decision ◽  
High Tech ◽  
Biological Drugs ◽  
Basic Principles ◽  
Tnf Α ◽  
Anti Inflammatory ◽  
Factor Α

The paper considers the modern concepts of the etiology and pathogenesis of psoriatic arthritis (PsA). The latter is currently indicated as a T-cell-mediated disease that is based on the activation of cellular immunity, followed by the hyperproduction and imbalance of key pro- and anti-inflammatory cytokines, such as tumor necrosis factor-α (TNF- α), interleukin-1β (IL-1β), IL-6, IL-12/23, and IL-17. The paper presents the basic principles of diagnosis and clinical manifestations of the disease and notes the importance of screening questionnaires, the use of which allows specialists to diagnose PsA early, by actively identifying articular complaints, the characteristic clinical and radiological signs of damage to the joint, spine, and entheses. It is pointed out that the key target of pharmacotherapy for PsA is to achieve remission or minimal activity of the main clinical manifestations of the disease, to slow down or prevent its radiographic progression, to increase the length and quality of life in patients, and to reduce the risk of comorbidities. The authors characterize the major groups of used drugs: nonsteroidal anti-inflammatory drugs, conventional and targeted synthetic disease-modifying antirheumatic drugs, and biological drugs (inhibitors of TNF-α, IL-12/23, and IL-17). The key Treat-to-target principles of patient management are considered; it is noted that strict control over disease activity and treatment results provides suppression of all major clinical manifestations of PsA. The paper also shows the basic principles of the creation and further development of the All-Russian Registry of PsA patients, which makes it possible to optimize management decision-making on the provision of high-tech medical care and drugs for this cohort of patients.

scholarly journals Experience in using secukinumab in patients with axial psoriatic arthritis

2020 ◽  
Vol 14 (4) ◽  
pp. 150-156
Author(s):  
E. E. Gubar ◽  
Yu. L. Korsakova ◽  
E. Yu. Loginova ◽  
T. V. Korotaeva
Keyword(s):  
Psoriatic Arthritis ◽  
Subjective Assessment ◽  
Axial Skeleton ◽  
Disease Modifying Antirheumatic Drugs ◽  
Biological Drugs ◽  
Skeletal Injury ◽  
Interleukin 17A ◽  
Inflammatory Drugs ◽  
Factor Α ◽  
Necrosis Factor

Axial skeletal injury is observed in 25–70% of patients with psoriatic arthritis (PsA). Spondylitis frequently occurs subclinically, which leads to serious structural and functional disorders over time. An update shows that axial skeleton involvement in PsA is characterized by a more severe clinical course: these patients are observed to have a greater severity of peripheral arthritis, enthesitis, and dactylitis, skin and nail psoriasis, a higher CRP level, and worse functional status. In addition, the disease is more severe according to the patients' subjective assessment, as evidenced by questionnaires. Synthetic disease-modifying antirheumatic drugs used to treat peripheral PsA are not recommended for axial injury. When nonsteroidal anti-inflammatory drugs are ineffective, biological drugs (tumor necrosis factor-α inhibitors or interleukin-17A (IL-17A) inhibitors) should be prescribed immediately to patients with psoriatic spondylitis. The paper describes two clinical cases demonstrating the successful use of the IL-17A inhibitor secukinumab (SEC) in patients with axial PsA (axPsA). Given the positive experience with SEC in real clinical practice, it seems reasonable to prescribe it to patients at earlier stages of axPsA.

scholarly journals Inhibitors of interleukin 17A in the treatment of psoriatic arthritis: what's new?

2021 ◽  
Vol 15 (2) ◽  
pp. 106-111
Author(s):  
Т. V. Korotaeva
Keyword(s):  
Psoriatic Arthritis ◽  
Observational Studies ◽  
Tumor Necrosis ◽  
Tumor Necrosis Factor Α ◽  
Axial Spondyloarthritis ◽  
First Line ◽  
Drug Of Choice ◽  
Interleukin 17A ◽  
Factor Α ◽  
Necrosis Factor

In recent years, highly effective target drugs – inhibitors of interleukin 17A (iIL17A) – monoclonal antibodies, – have been widely used to treat patients with psoriatic arthritis (PsA). The efficacy of iIL-17A in psoriasis, PsA, and axial spondyloarthritis has been proven in large multicenter randomized clinical and observational studies. The accumulated evidence and first direct comparative studies with inhibitors of tumor necrosis factor α (iTNFα) suggest that this class of drugs is becoming one of the key drugs in PsA, and the choice of this therapy is more justified, which is reflected in international recommendations. The 2019 revised EULAR guidelines consider iIL 17 first-line biologics along with iTNF-α, whereas iIL-17A is a drug of choice in patients with significant concomitant skin psoriasis.

Biological Therapy for Psoriatic Arthritis in Clinical Practice: Outcomes Up to 2 Years

2010 ◽  
Vol 37 (11) ◽  
pp. 2362-2368 ◽  
Author(s):  
LIISA M. VIRKKI ◽  
BINDU C. SUMATHIKUTTY ◽  
MERJA AARNIO ◽  
HEIKKI VALLEALA ◽  
RIITTA HEIKKILÄ ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Health Assessment ◽  
Routine Care ◽  
Biological Drugs ◽  
Acr20 Response ◽  
Reactive Protein ◽  
American College Of Rheumatology ◽  
Factor Α ◽  
Assessment Questionnaire ◽  
Necrosis Factor

Objective.To evaluate the performance of biological drugs in psoriatic arthritis (PsA) in a routine care setting, using the Finnish national register of biological treatment (ROB-FIN).Methods.Patients with PsA who started therapy with infliximab or etanercept between June 2000 and February 2006 (n = 127) were followed for up to 24 months. Response was evaluated using American College of Rheumatology response criteria including individual measures.Results.Significantly diminished values for swollen and tender joints, patient’s global and pain assessments, doctor’s global assessment of disease activity, erythrocyte sedimentation rate, C-reactive protein, and Health Assessment Questionnaire score were observed within 3 months after commencement of both infliximab and etanercept. Values remained significantly lower throughout the 24 months of followup. ACR20 response at 3 months was 79% (n = 22/28) for infliximab and 76% (n = 34/45) for etanercept. The first biological drug was discontinued in 16% due to lack of effectiveness and in 6% due to adverse events.Conclusion.Anti-tumor necrosis factor-α therapy, often combined with conventional disease-modifying antirheumatic drugs, appeared to have limited toxicity and persistent effectiveness for up to 2 years in a cohort of Finnish patients with severe peripheral PsA.

scholarly journals Psoriatic onychodystrophy: clinical manifestations (part 1)

2019 ◽  
Vol 94 (6) ◽  
pp. 7-14
Author(s):  
A. V. Platonova ◽  
A. S. Zhukov ◽  
V. R. Khairutdinov ◽  
A. V. Samtsov
Keyword(s):  
Psoriatic Arthritis ◽  
Prognostic Value ◽  
Clinical Manifestations ◽  
Pathological Changes ◽  
Nail Bed ◽  
Nail Changes ◽  
Wide Range ◽  
Mechanisms Of Formation ◽  
The Relationship ◽  
Dystrophic Nail

Psoriatic onychodystrophy is quite common in patients with psoriasis. Changes in psoriatic nails have a wide range of clinical manifestations, including symptoms of damage of the nail bed and/or nail matrix. The article presents information about clinical and pathological manifestations of psoriatic onychodystrophy, the mechanisms of formation of pathological changes. The existence of the relationship between the change of nail plates in patients with psoriasis and the development of psoriatic arthritis is explained, the prognostic value of individual symptoms is analyzed. The diagnostic criteria for the histological diagnosis of psoriatic onychodystrophy are described. The information about the occurrence of each symptom in patients with psoriasis with dystrophic nail changes is given.

Rare Clinical Case of Cryopyrin-Associated Periodic Syndrome Presented with Ankylosing Spondylitis: A Case Report

2021 ◽  
Vol 17 ◽  
Author(s):  
Anna A. Zayaeva ◽  
Lyudmila V. Sokolova ◽  
Denis V. Shaduro ◽  
Andrey V. Petrov ◽  
Shanmugaraj Kulanthaivel ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Clinical Case ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Treatment Method ◽  
Genetically Engineered ◽  
Periodic Syndrome ◽  
Biological Drugs ◽  
Nlrp3 Gene ◽  
Long Time

Background: Cryopyrin-Associated Periodic Syndrome (CAPS) is a variety of clinical variants of autoinflammatory diseases. The pathology is based on a mutation in the NLRP3 gene encoding the cryopyrin protein, which leads to the uncontrolled production of interleukin-1β. Particular attention should be paid to the rarity of this disease and the lack of clinical knowledge about it in therapeutic and rheumatological practice, which leads to an erroneous diagnosis and the appointment of ineffective treatment for a long time, leading to the progression of the disease and disability of the patient. Case Presentation: This article describes a clinical case of this disease. The first manifestations of the disease in a woman appeared from the age of 2 years, in the form of a rash and fever. Since school age, there have been signs of arthritis. By the age of 24, sensorineural hearing loss and pain in the spine were evident. The disease occurred under the clinical manifestations of spondyloarthritis. Its treatment with anti-inflammatory therapy did not give a stable result. Conclusion: From the analysis, we can conclude that patient M. from early childhood suffers from a severe Neonatal-onset Multisystem Inflammatory Disease of a genetic nature. For a long time, the patient was diagnosed with ankylosing spondylitis, and appropriate treatment was carried out without significant success. The correct diagnosis of CAPS was made only in 2018. This patient has conditions of both CAPS and AS together, which is a very rare association in rheumatological practice. The only treatment method that could stop the manifestations of the disease and prevent life-threatening kidney damage (amyloidosis) is the use of genetically engineered biological drugs, i.e., IL-1β inhibitors. The only drug of this group registered in Russia is canakinumab (Ilaris ®). From the moment of diagnosis to the present day, the patient is treated with the genetically engineered drug canakinumab (Ilaris ®) at a dose of 150 mg once every 8 weeks. 6 months after taking the drug, the patient went into complete clinical and laboratory remission.

Finding at dermatologist’s appointment: linear porokeratosis

2021 ◽  
pp. 45-48
Author(s):  
N. E. Manturova ◽  
A. L. Rodina
Keyword(s):  
Histological Examination ◽  
Skin Disease ◽  
Medical Records ◽  
Clinical Case ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Trigger Factors ◽  
Biopsy Material ◽  
Wide Range ◽  
Clinical Variants

The article deals with the epidemiology, pathomorphological picture, trigger factors of development, clinical manifestations and forms, diagnosis, and peculiarities of treatment of linear porokeratosis. A clinical case is presented.Purpose of the article. To consider the clinical manifestations and peculiarities of the course of porokeratosis, paying special attention to linear porokeratosis and its management tactics.Material and methods. The article presents a clinical case of linear porokeratosis. The analysis of medical records was carried out. The forms of porokeratosis, clinical manifestations, peculiarities of diagnosis and approaches to the treatment of porokeratosis in modern conditions are considered.Results. This clinical case demonstrates the difficulty of making a diagnosis of linear porokeratosis. The diagnosis was made based on the results of histological examination of biopsy material. A tactic for the management of the patient was developed.Conclusions. Porokeratosis is a rare skin disease with a wide range of clinical variants, which is important for clinicians to know in order to make a correct diagnosis and avoid errors in diagnosis. The clinical manifestations of the disease are varied, with localized, disseminated, and rash forms.

scholarly journals A clinical case of congenital hyperinsulinism in an early child

2020 ◽  
Vol 11 (3) ◽  
pp. 54-59
Author(s):  
S. B. Berezhansky ◽  
A. A. Afonin ◽  
E. A. Papsheva ◽  
N. N. Vostrykh ◽  
G. A. Galkina ◽  
...  
Keyword(s):  
Clinical Case ◽  
Severe Disease ◽  
Clinical Manifestations ◽  
Heterozygous Mutation ◽  
Congenital Hyperinsulinism ◽  
Early Child ◽  
Wide Range ◽  
Diffuse Form ◽  
Long Term Prognosis

A clinical case of congenital hyperinsulinism, diffuse form, pharmacoresistant course (heterozygous mutation of p. 1361 1363 dup CGG in the GCK gene) in an early child is presented as an example of an orphan severe disease with an extremely unfavorable course and a probability of deterioration of the long-term prognosis. The goal was to highlight the clinical manifestations, course options, and complexity of treatment of this pathology to a wide range of doctors of different specialties in the field of Pediatrics in terms of improving the quality and timeliness of diagnosis, reducing the number of complications with the formation of irreparable consequences. Attention is drawn to the most severe course of hypoglycemic conditions in the early neonatal period, the dependence of the formation of a pronounced neurological deficit on the degree and duration of hypoglycemia, which emphasizes the importance of their timely correction to preserve the quality of life of this contingent of children.

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