CLINICAL AND PATHOGENETIC FEATURES OF PSORIASIS IN PATIENTS WITH METABOLIC SYNDROME AND WAYS OF IMPROVING PERSONALIZED THERAPY

Abstract

Relevance. Psoriasis is a chronic immune-inflammatory disease that is often combined with metabolic syndrome (MS), which leads to a more severe course of the skin process, increased systemic inflammation and reduced effectiveness of standard therapy. The common pathogenetic mechanisms of psoriasis and MS — activation of the IL-23/Th17 axis, an excess of pro-inflammatory cytokines, insulin resistance and disturbance of the adipokine profile — make the search for personalised approaches to treatment relevant. Aim of the study. To study the clinical and pathogenetic features of psoriasis in patients with metabolic syndrome and to assess the effectiveness of a personalised therapeutic strategy in comparison with standard treatment. Materials and methods. A prospective study of 112 patients with plaque psoriasis was carried out; they were divided into two groups: the main group (n = 58) — patients with psoriasis and MS, and the control group (n = 54) — without MS. PASI, BSA, DLQI, the indicators of carbohydrate and lipid metabolism and the levels of TNF-α, IL-6, IL-17A, CRP, insulin and HOMA-IR were assessed. The effectiveness of therapy was analysed according to the PASI-50/75/90 criteria. Student's t-test, the Mann–Whitney U test and χ² were applied. Results. Patients with MS showed higher indicators of psoriasis severity (PASI 19.4 ± 6.2 versus 13.7 ± 4.8; p < 0.01), a greater extent of lesions (BSA 24.6 ± 8.1 versus 16.3 ± 5.7; p < 0.01) and a greater reduction in quality of life (DLQI 17.2 ± 5.4 versus 11.6 ± 4.2; p < 0.01). A significant increase in TNF-α, IL-17A, CRP and HOMA-IR was established (p < 0.01), as well as the correlations PASI ↔ IL-17A (r = 0.61) and PASI ↔ HOMA-IR (r = 0.54). Personalised therapy showed superiority over standard therapy: PASI-75 was achieved in 67 % versus 38 % (p < 0.01) and PASI-90 in 41 % versus 19 % (p < 0.05). Conclusion. Metabolic syndrome contributes to a more severe clinical course of psoriasis and reduces the effectiveness of traditional therapy. A personalised approach that takes into account metabolic status, the levels of pro-inflammatory cytokines and insulin resistance provides a more pronounced therapeutic response and should be regarded as the preferred management strategy for this category of patients.