Alʹmanah Kliničeskoj Mediciny (Nov 2018)
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)
Abstract
Psoriasis, psoriatic arthritis (PsA) and inflammatory bowel disease (IBD) are multifactorial chronic immunoinflammatory disorders with characteristic common genetic markers that determine their common pathophysiology and similar immune abnormalities. In particular, IL12/23 signaling pathway of the immune pathogenesis of the above mentioned diseases is related to the IL23R gene polymorphism. Common pathophysiological features, in their turn, produce a high risk and prevalence of comorbidity. Clinicians' unawareness of these particulars of the immunoinflammatory disorders might lead to the absence of interdisciplinary collaboration, late diagnosis of one of these disorders and polypharmacy, because each specialist (i.e., a dermatologist, a rheumatologist, a gastroenterologist) would administer his/hers treatments independently. In this context, the issues of the multidisciplinary approach to this problem are becoming highly relevant for earlier diagnosis and adequate treatment choice that is optimal for all disorders which contribute to the pathological process, taking into account common mechanism of their development. Therefore, there is the necessity to establish an interdisciplinary working group consisting of the leading specialists of the Russian Federation in rheumatology, dermatology, and gastroenterology, with a purpose to elaborate a consensus on the immunoinflammatory comorbidities. At the discretion of the Russian Association of Rheumatologists (RAR), Russian Society of Dermatovenerologists and Cosmetologists (RSDVC), Russian IBD Study Society (RIBDS), such a group has been formed of 11 experts corresponding to their scientific expertise in the area. The main aim of the Working Group was to develop a universal interdisciplinary questionnaire for detection of the signs and symptoms of the immunoinflammatory disorders (psoriasis, PsA, IBD), as well as development of a draft project of the interdisciplinary guidelines on the early diagnosis, methods of activity assessment and indications to the use of genetically engineered biological agents in patients with comorbid immunoinflammatory comorbidities (psoriasis, PsA, IBD). Procedure of the interdisciplinary guidelines elaboration. The Working Group elaborated a draft project of the up-to-date evidence-based guidelines and proposed a multidisciplinary questionnaire. An interdisciplinary expert council of specialists in dermatology, rheumatology and gastroenterology discussed each position of the proposed guidelines and was adopted by a simple majority of votes through an open votingat the Second Russian Debates “Dermatology, Rheumatology, Gastroenterology: focus on the interdisciplinary interaction” (Moscow, December 12–13, 2017). Results: 1. A universal interdisciplinary questionnaire to detect clinical signs of immunoinflammatory disorders (psoriasis, PsA, IBD) hasbeen created. It contains the main questions the answers to which are needed for a specialist physician (a dermatologist, a rheumatologist or a gastroenterologist) to suspect comorbidity and to refer the patient to a corresponding specialist. The questionnaire has three parts, each of them with questions to the patient aimed at the detection of the symptoms of psoriasis, PsA, and IBD. 2. An algorithm for interaction between dermatologists, rheumatologists and gastroenterologists has been developed aimed at optimal management of patients with comorbid immunoinflammatory disorders. 3. Goals of treatment of immunoinflammatory disorders (psoriasis, PsA, Crohn's disease) have been formulated according to the “treat-to-target” (Т2Т) concept. 4. Criteria for assessment of activity and severity of the immunoinflammatory disorders (psoriasis, PsA, and Crohn's disease) have been formulated. 5. The draft describes the indications for the administration of genetically engineered biological agents (GEBA), factors influencing the choice of treatment, criteria for GEBA efficacy assessment, indications to a change of a GEBA in primary or secondary treatment failure. Conclusion: In accordance with the results of discussion with specialists from various regions of the Russian Federation and with the decision ofthe Expert Council, it is planned to validate thequestionnaire, with subsequent inclusion of the position of the draft project into the clinical guidelines on the management of patients with psoriasis, PsA, and Crohn's disease.
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