Experience of an integrated approach to the management of patients with psoriasis taking into account comorbid conditions and the impact of adverse environmental factors

Gadzhimuradova K.M., Torshina I.E., Gadzhimuradov M.N.

1) Dagestan State Medical University, Makhachkala, Russia; 2) Smolensk State Medical University, Smolensk, Russia

Background: Manifestation of psoriasis is attributable to the genetic predisposition and the influence of environmental agents (pesticides, sulfur and nitrogen dioxide, heavy metals, hydrocarbons). Psoriasis is associated with a persistent tendency to the formation of comorbid pathology, such as joint, cardiovascular, endocrine, renal, hepatic, neurological, as well as uveitis and metabolic disorders. In connection with the above mentioned, an integrated interdisciplinary approach is necessary in the follow-up care of patients with psoriasis and a personalized selection of a treatment regimen. Objective: Development of mechanisms for preventing relapses and complications of psoriasis occurring against the background of multiple organ pathology and environmental stress. Materials and methods: The study included 84 patients with psoriasis living in nine municipalities of the Republic of Dagestan - in five districts and four cities. Results: The study group had a high frequency of arthropathy (from 45.5% to 80.0%) and pain syndrome in one of the joints (from 45.5% to 100.0%). Combination therapy for arthralgia included nonsteroidal anti-inflammatory drugs (NSAIDs) (34.52%, CI 95%: 24.8–45.0%) and glucocorticosteroids (30.95%, CI 95%: 21.6–41.2%). Topical therapy and physiotherapy were used for stabili-zing and regressing the skin process and preventing arthropathy. Restoration of liver function was necessary in 53.57% (CI 95%: 42.9–64.1%) of patients. In an ecologically safe municipality (Khiva district), 32.0% of patients with psoriasis were removed from the follow-up care register in 2020–2023 due to long-term remission and the absence of relapses. In areas with a tense environment, for example, in the city of Khasavyurt, the proportion of those removed from the register was 3.2%, in the Derbent district – 1.7%, the differences with the Khiva district were statistically significant in all cases (p<0.001). The above mentioned trend was recorded in all administrative units with a tense environment. Conclusion: In conditions of environmental pollution and multimorbidity, resistance to therapy and the development of psoriasis complications are noted. An interdisciplinary approach to dynamic monitoring with the involvement of leading specialists contributes to the prevention of disabling psoriasis complications.

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About the Authors

Kamilla M. Gadzhimuradova, Teaching Assistant, Department of Dermatovenereology and Cosmetology, Dagestan State Medical University, Makhachkala, Russia; gadzhimuradova.kamilla@mail.ru, eLibrary SPIN: 4312-6067, ORCID: https://orcid.org/0000-0001-8101-1665
Irina E. Torshina, Dr. Sci. (Med.), Associate Professor, Head of the Department of Skin and Venereal Diseases with a Course in Medical Cosmetology, Smolensk State Medical University, Smolensk, Russia; irina-torsina@mail.ru, eLibrary SPIN: 1222-6560, ORCID: https://orcid.org/0000-0002-6562-0556
Marat N. Gadzhimuradov, Dr. Sci. (Med.), Associate Professor, Head of the Department of Dermatovenereology and Cosmetology, Dagestan State Medical University, Makhachkala, Russia; gabenu@mail.ru, eLibrary SPIN: 9611-5619, ORCID: https://orcid.org/0000-0002-3663-3235 (corresponding author)

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