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

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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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作者简介

Kamilla Gadzhimuradova

Dagestan State Medical University

Email: gadzhimuradova.kamilla@mail.ru
ORCID iD: 0000-0001-8101-1665
SPIN 代码: 4312-6067

Teaching Assistant, Department of Dermatovenereology and Cosmetology

俄罗斯联邦, Makhachkala

Irina Torshina

Smolensk State Medical University

Email: irina-torsina@mail.ru
ORCID iD: 0000-0002-6562-0556
SPIN 代码: 1222-6560

Dr. Sci. (Med.), Associate Professor, Head of the Department of Skin and Venereal Diseases with a Course in Medical Cosmetology

俄罗斯联邦, Smolensk

Marat Gadzhimuradov

Dagestan State Medical University

编辑信件的主要联系方式.
Email: irina-torsina@mail.ru
ORCID iD: 0000-0002-3663-3235
SPIN 代码: 9611-5619

Dr. Sci. (Med.), Associate Professor, Head of the Department of Dermatovenereology and Cosmetology

俄罗斯联邦, Makhachkala

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2. Figure 1. Algorithm for remote consultation by specialized specialists of the Dagestan State Medical University of the Ministry of Health of the Russian Federation

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3. Figure 2. Polyclinic level, with telemedicine participation of specialized specialists of the Dagestan State Medical University of the Ministry of Health of the Russian Federation

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4. Figure 3. Results of outpatient management of patients with psoriasis during the year by expert specialists

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