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)

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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.

About the authors

D. I. Abdulganieva

Kazan State Medical University

Email: fake@neicon.ru

Diana I. Abdulganieva - MD, PhD, Professor, Head of the Chair of Hospital Therapy.

49 Butlerova ul., Kazan, 420012.

Россия

A. L. Bakulev

Saratov State Medical University named after V.I. Razumovsky

Email: fake@neicon.ru

Andrey L. Bakulev - MD, PhD, Professor, Chair of Dermatovenereology and Cosmetology.

112 Bol'shaya Kazach'ya ul., Saratov, Saratovskaya oblast', 410012.

Россия

E. A. Belousova

Moscow Regional Research and Clinical Institute (MONIKI)

Author for correspondence.
Email: eabelous@yandex.ru

Elena A. Belousova - MD, PhD, Professor, Head of Department of Gastroenterology and Hepatology; Head of the Chair of Gastroenterology, Postgraduate Training Faculty.

61/2-9 Shchepkina ul., Moscow, 129110.

Tel.: +7 (495) 684 48 58.

Россия

L. F. Znamenskaya

State Research Center for Dermatology, Venereology and Cosmetology

Email: fake@neicon.ru

Lyudmila F. Znamenskaya - MD, PhD, Leading Research Fellow, Department of Dermatology.

3 Korolenko ul., Moscow, 107076.

Россия

T. V. Korotaeva

V.A. Nasonova Research Institute of Rheumatology

Email: tatianakorotaeva@gmail.com

Tatyana V. Korotaeva - MD, PhD, Leading Research Fellow, Laboratory of Innovative Methods for Diagnosis and Treatment of Psoriatic Arthritis.

34A Kashirskoe shosse, Moscow, 115522.

Tel.: +7 (916) 319 25 71.

Россия

L. S. Kruglova

Central State Medical Academy of Department of Presidential Affairs

Email: fake@neicon.ru

Larisa S. Kruglova - MD, PhD, Head of the Chair of Dermatovenereology and Cosmetology.

19–1А Marshalа Timoshenko ul., Moscow, 121359.

Россия

M. M. Kokhan

Ural Research Institute of Dermatovenerology and Immunopathology

Email: fake@neicon.ru

Muza M. Kokhan - MD, PhD, Professor, Head of the Department of Dermatology Clinical Research.

8 Shcherbakova ul., Ekaterinburg, 620076.

Россия

A. M. Lila

V.A. Nasonova Research Institute of Rheumatology

Email: fake@neicon.ru

Aleksandr M. Lila - MD, PhD, Professor, Director.5

34A Kashirskoe shosse, Moscow, 115522.

Россия

V. R. Khayrutdinov

Military Medical Academy named after S.M.Kirov

Email: fake@neicon.ru

Vladislav R. Khayrutdinov - MD, PhD, Assistant, Chair of Skin and Venereal Diseases.

6G Akademika Lebedeva ul., Saint Petersburg, 194044.

Россия

I. L. Khalif

Ryzhikh State Scientific Center of Coloproctology

Email: fake@neicon.ru

Igor L. Khalif - MD, PhD, Professor, Head of the Department of Inflammatory and Functional Bowel Diseases.

2 Salyama Adilya ul., Moscow, 123423.

Россия

M. M. Khobeysh

Pavlov First Saint Petersburg State Medical University

Email: mkhobeysh@yandex.ru

Marianna M. Khobeysh - MD, PhD, Associate Professor, Chair and Clinic of Dermatovenereology, Head of the Center of Genetically Engineered Biologic Therapy.

6-8 L'va Tolstogo ul., Saint Petersburg, 197022.

Tel.: +7 (812) 338 71 72.

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Copyright (c) 2018 Abdulganieva D.I., Bakulev A.L., Belousova E.A., Znamenskaya L.F., Korotaeva T.V., Kruglova L.S., Kokhan M.M., Lila A.M., Khayrutdinov V.R., Khalif I.L., Khobeysh M.M.

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