Russian interdisciplinary consensus on the definitions of “difficult-to-manage” and “difficult-to-treat” psoriatic arthritis/psoriasis and the management of these patients
https://doi.org/10.14412/1996-7012-2026-3-108-119
Abstract
The results of the Russian interdisciplinary consensus on the definitions of “difficult-to-manage” and “difficult-to-treat” psoriatic arthritis/psoriasis are presented. Rheumatology and dermatovenereology experts participated in a Delphi-method voting process.
About the Authors
A. M LilaRussian Federation
34A, Kashirskoe Shosse, Moscow 115522
2/1, Barrikadnaya Street, Build. 1, Moscow 125993
T. V. Korotaeva
Russian Federation
Tatyana Viktorovna Korotaeva
34A, Kashirskoe Shosse, Moscow 115522
L. S. Kruglova
Russian Federation
19, Marshala Timoshenko Street, Build. 1A, Moscow 121359
E. Yu. Loginova
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
Yu. L. Korsakova
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
E. E. Gubar
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
I. M. Patrikeeva
Russian Federation
55, Kotovskogo Street, Tyumen 625023
P. A. Shesternya
Russian Federation
1, Partizana Zheleznyaka Street, Krasnoyarsk 660022
Z. Yu. Mutovina
Russian Federation
3, Pekhotnaya Street, Moscow 123182
A. I. Zagrebneva
Russian Federation
3, Pekhotnaya Street, Moscow 123182
I. B. Vinogradova
Russian Federation
7, Tretyego Internatsionala Street, Ulyanovsk 432017
R. R. Samigullina
Russian Federation
41, Kirochnaya Street, Saint Petersburg 191015
S. P. Yakupova
Russian Federation
49, Butlerova Street, Kazan 420012
T. S. Panevin
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
V. R. Khairutdinov
Russian Federation
6, Academician Lebedeva Street, Saint Petersburg 194044
A. L. Bakulev
Russian Federation
19, Marshala Timoshenko Street, Build. 1A, Moscow 121359
112, Bolshaya Kazachya Street, Saratov 410012
N. O. Pereverzina
Russian Federation
30, Volokolamskoe Shosse, Build. 2, Moscow 123182
E. A. Shatokhina
Russian Federation
19, Marshala Timoshenko Street, Build. 1A, Moscow 121359
27, Lomonosovsky Prospekt, Build. 10, Moscow 119234
N. N. Murashkin
Russian Federation
19, Marshala Timoshenko Street, Build. 1A, Moscow 121359
2, Lomonosovsky Prospekt, Build. 1, Moscow 119991
A. A. Khotko
Russian Federation
179, Rashpilevskaya Street, Build. 1, Krasnodar 350020
N. S. Rudneva
Russian Federation
92, Lenina Avenue, Tula 300012
I. S. Vladimirova
Russian Federation
6, Academician Lebedeva Street, Saint Petersburg 194044
O. A. Sidorenko
Russian Federation
29, Nakhichevansky Lane, Rostov-on-Don 344022
I. G. Sergeeva
Russian Federation
1, Pirogova Street, Novosibirsk 630090
Yu. Yu. Vinnik
Russian Federation
1, Partizana Zheleznyaka Street, Krasnoyarsk 660022
P. V. Gorodnichev
Russian Federation
49G, Kovalikhinskaya Street, Nizhny Novgorod 603950
Z. R. Khismatullina
Russian Federation
3, Lenina Street, Ufa 450008
References
1. Deev IA, Kobyakova OS, Starodubov VI, et al. Morbidity of the entire Russian population in 2023: statistical materials. Moscow: FGBU «TsNIIOIZ» Minzdrava Rossii; 2024. 154 p.
2. Alinaghi F, Calov M, Kristensen LE, et al. Prevalence of psoriatic arthritis in patients with psoriasis: A systematic review and metaanalysis of observational and clinical studies. J Am Acad Dermatol. 2019 Jan;80(1):251-265 .e19. doi: 10.1016/j.jaad.2018.06.027.
3. Ghoreschi K, Balato A, Enerbäck C, Sabat R. Therapeutics targeting the IL-23 and IL-17 pathway in psoriasis. Lancet. 2021 Feb 20; 397(10275):754-766. doi: 10.1016/S0140- 6736(21)00184-7.
4. Korsakova YuL, Korotaeva TV, Loginova EYu, et al. Prevalence of comorbid and concomitant diseases in psoriatic arthritis according to the All-Russian Registry of patients with psoriatic arthritis. Nauchno-prakticheskaya revmatologiya. 2021;59(3):275-281. (In Russ.).
5. Kaushik SB, Lebwohl MG. Psoriasis: Which therapy for which patient: Psoriasis comorbidities and preferred systemic agents. J Am Acad Dermatol. 2019 Jan;80(1):27-40. doi: 10.1016/j.jaad.2018.06.057.
6. Lubrano E, Scriffignano S, Azuaga AB. Impact of comorbidities on disease activity, patient global assessment and function in Psoriatic Arthritis: A Cross-Sectional Study. Rheumatol Ther. 2020 Dec;7(4):825-836. doi: 10.1007/s40744-020-00229-0.
7. Biedro G, Wilk M, Nowakowski J, et al. Impact of comorbidities on patient-reported outcomes in psoriatic arthritis: a single centre cohort study. Rheumatol Int. 2024 Aug;44(8): 1435-1443. doi: 10.1007/s00296-024-05632-2.
8. https://cr.minzdrav.gov.ru/view-cr/234_2
9. Gisondi P, Talamonti M, Chiricozzi A, et al. Treat-to-Target Approach for the Management of Patients with Moderate-to-Severe Plaque Psoriasis: Consensus Recommendations. Dermatol Ther (Heidelb). 2021 Feb;11(1): 235-252. doi: 10.1007/s13555-020-00475-8.
10. Huang YW, Tsai TF. Remission Duration and Long-Term Outcomes in Patients with Moderate-to-Severe Psoriasis Treated by Biologics or Tofacitinib in Controlled Clinical Trials: A 15-Year Single-Center Experience. Dermatol Ther (Heidelb). 2019 Sep;9(3):553- 569. doi: 10.1007/s13555-019-0310-5.
11. https://onlinelibrary.wiley.com/doi/full/10.1155/jcpt/6541156
12. Proft F, Ribeiro AL, Singla S, et al. Consensus definitions of complex-to-manage and treatment-refractory psoriatic arthritis: a GRAPPA initiative. Nat Rev Rheumatol. 2026 Feb;22(2):132-144. doi: 10.1038/s41584-025-01329-3.
13. Marzo-Ortega H, Harrison SR, Fragoulis GE, et al. EULAR points to consider and consensus definitions for difficult-to-manage and treatment-refractory psoriatic arthritis. Ann Rheum Dis. 2026 Jan;85(1):61-74. doi: 10.1016/j.ard.2025.10.002.
14. Nicolescu AC, Ionescu MA, Constantin MM, et al. Psoriasis Management Challenges Regarding Difficult-to-Treat Areas: Therapeutic Decision and Effectiveness. Life (Basel). 2022 Dec 7;12(12):2050. doi: 10.3390/life12122050.
15. Sarma N. Evidence and Suggested Therapeutic Approach in Psoriasis of Difficult-totreat Areas: Palmoplantar Psoriasis, Nail Psoriasis, Scalp Psoriasis, and Intertriginous Psoriasis. Indian J Dermatol. 2017 Mar-Apr;62(2): 113-122. doi: 10.4103/ijd.IJD_539_16.
16. Mastorino L, Roccuzzo G, Dapavo P, et al. Patients with psoriasis resistant to multiple biological therapies: characteristics and definition of a difficult-to-treat population. Br J Dermatol. 2022 Aug;187(2):263-265. doi: 10.1111/bjd.21048.
17. Magnano M, Loi C, Patrizi A, et al. Secukinumab in multi-failure psoriatic patients: the last hope? J Dermatolog Treat. 2018 Sep;29(6):583-585. doi: 10.1080/09546634.2018. 1427206.
18. Megna M, Fabbrocini G, Ruggiero A, Cinelli E. Efficacy and safety of risankizumab in psoriasis patients who failed anti-IL-17, anti-12/23 and/or anti IL-23: Preliminary data of a real-life 16-week retrospective study. Dermatol Ther. 2020 Nov;33(6):e14144. doi: 10.1111/dth.14144.
19. Lorenzin M, Ortolan A, Cozzi G, et al. Predictive factors for switching in patients with psoriatic arthritis undergoing antiTNFα, anti-IL12/23, or anti-IL17 drugs: a 15-year monocentric real-life study. Clin Rheumatol. 2021 Nov;40(11):4569-4580. doi: 10.1007/s10067-021-05799-0.
20. https://cr.minzdrav.gov.ru/view-cr/562_3
21. Scala E, Mercurio L, Albanesi C, Madonna S. The Intersection of the Pathogenic Processes Underlying Psoriasis and the Comorbid Condition of Obesity. Life (Basel). 2024 Jun 7; 14(6):733. doi: 10.3390/life14060733.
22. Chiricozzi A, Gisondi P, Girolomoni G. The pharmacological management of patients with comorbid psoriasis and obesity. Expert Opin Pharmacother. 2019 May;20(7):863-872. doi: 10.1080/14656566.2019.1583207.
23. Currado D, Trunfio F, Saracino F, et al. Patients with psoriatic arthritis and comorbid metabolic syndrome show a difficult-to-treat phenotype: another mosaic tile in the definition of a still undefined subset of patients. RMD Open. 2025 Jun 22;11(2):e005717. doi: 10.1136/rmdopen-2025-005717.
24. Landgren AJ, Jonsson CA, Bilberg A, et al. Sex differences in cytokines and adipokines in obese patients with PsA and controls undergoing a weight loss intervention. RMD Open. 2024 Mar 22;10(1):e003821. doi: 10.1136/rmdopen-2023-003821.
25. di Minno MN, Peluso R, Iervolino S, et al. Obesity and the prediction of minimal disease activity: a prospective study in psoriatic arthritis. Arthritis Care Res (Hoboken). 2013 Jan; 65(1):141-7. doi: 10.1002/acr.21711.
26. Nicolau J, Nadal A, Sanchнs P, et al. Effects of liraglutide among patients living with psoriasis and obesity. Med Clin (Barc). 2023 Oct 13;161(7):293-296. doi: 10.1016/j.medcli.2023.05.021.
27. Patsalos O, Dalton B, Leppanen J, et al. Impact of TNF-α Inhibitors on Body Weight and BMI: A Systematic Review and MetaAnalysis. Front Pharmacol. 2020 Apr 15:11:481. doi: 10.3389/fphar.2020.00481.
28. Gialouri CG, Evangelatos G, Fragoulis GE. Choosing the Appropriate Target for the Treatment of Psoriatic Arthritis: TNFα, IL-17, IL-23 or JAK Inhibitors? Mediterr J Rheumatol. 2022 Apr 15;33(Suppl 1):150-161. doi: 10.31138/mjr.33.1.150.
29. Siebert S, Sattar N, Ferguson LD. Weighing in on obesity and psoriatic arthritis – Time to move beyond association to robust ran domised trials. Joint Bone Spine. 2025 Oct; 92(5):105904. doi: 10.1016/j.jbspin.2025.105904.
30. Carter K, Cheung WY, Hutchings HA, et al. The efficacy and safety of ustekinumab in adolescents newly diagnosed with type 1 diabetes: the USTEK1D RCT. Efficacy Mech Eval. 2025;12(1). doi: 10.3310/FQLN7416.
31. da Silva BS, Bonfa E, de Moraes JC, et al. Effects of anti-TNF therapy on glucose metabolism in patients with ankylosing spondylitis, psoriatic arthritis or juvenile idiopathic arthritis. Biologicals. 2010 Sep;38(5):567-9. doi: 10.1016/j.biologicals.2010.05.003
32. Solomon DH, Massarotti E, Garg R, et al. Association between disease-modifying antirheumatic drugs and diabetes risk in patients with rheumatoid arthritis and psoriasis. JAMA. 2011 Jun 22;305(24):2525-31. doi: 10.1001/jama.2011.878.
33. Puig L, Korman N, Greggio C, et al. Long-term hemoglobin A1c changes with apremilast in patients with psoriasis and psoriatic arthritis: pooled analysis of phase 3 ESTEEM and PALACE trials and phase 3b LIBERATE trial. J Am Acad Dermatol. 2019; 81AB:89. doi: 10.1016/j.jaad.2019.06.346
34. Hwang JL, Weiss RE. Steroid-induced diabetes: a clinical and molecular approach to understanding and treatment. Diabetes Metab Res Rev. 2014 Feb;30(2):96-102. doi: 10.1002/dmrr.2486.
35. Katsuyama T, Sada KE, Namba S, et al. Risk factors for the development of glucocorticoid-induced diabetes mellitus. Diabetes Res Clin Pract. 2015 May;108(2):273-9. doi: 10.1016/j.diabres.2015.02.010. 36. https://grls.minzdrav.gov.ru/Grls_View_v2.aspx?routingGuid=a743da4e-2850-4ede-b1b4-4b0ab1071e4b
36. Zusman EZ, Howren AM, Park JYE, et al. Epidemiology of depression and anxiety in patients with psoriatic arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum. 2020 Dec;50(6):1481-1488. doi: 10.1016/j.semarthrit.2020.02.001.
37. Goel N, Wallace EB, Lindsay C. Hot Topics: Depression in Individuals With Psoriasis and Psoriatic Arthritis. J Rheumatol. 2024 Oct 1;51(Suppl 2):43-50. doi: 10.3899/jrheum.2024-0362.
38. Bell KA, Balogh EA, Feldman SR. An update on the impact of depression on the treatment of psoriasis. Expert Opin Pharmacother. 2021 Apr;22(6):695-703. doi: 10.1080/14656566.2020.1849141.
39. Wang X, Wu L, Liu J, et al. The neuroimmune mechanism of pain induced depression in psoriatic arthritis and future directions. Biomed Pharmacother. 2025 Jan:182:117802. doi: 10.1016/j.biopha.2024.117802.
40. Kamalaraj N, El-Haddad C, Hay P, Pile K. Systematic review of depression and anxiety in psoriatic arthritis. Int J Rheum Dis. 2019 Jun;22(6):967-973. doi: 10.1111/1756-185X.13553.
41. Mathew AJ, Chandran V. Depression in Psoriatic Arthritis: Dimensional Aspects and Link with Systemic Inflammation. Rheumatol Ther. 2020 Jun;7(2):287-300. doi: 10.1007/s40744-020-00207-6.
42. Wang M, Sun Y, Sun Y. Efficacy and safety of drugs for psoriasis patients with mental disorders: A systematic review. J Affect Disord. 2024 Nov 15:365:112-125. doi: 10.1016/j.jad.2024.08.077.
43. Sood A, Raji MA. Cognitive impairment in elderly patients with rheumatic disease and the effect of disease-modifying anti-rheumatic drugs. Clin Rheumatol. 2021 Apr;40(4): 1221-1231. doi: 10.1007/s10067-020-05372-1.
44. Reich K, Foley P, Han C, et al. Guselkumab improves work productivity in patients with moderate-to-severe psoriasis with or without depression and anxiety: results from the VOYAGE 2 comparator study versus adalimumab. J Dermatolog Treat. 2020 Sep;31(6):617-623. doi: 10.1080/ 09546634.2019.1628172.
45. Sebbag E, Lauper K, Molina-Collada J, et al. 2024 EULAR points to consider on the initiation of targeted therapies in patients with inflammatory arthritis and a history of cancer. Ann Rheum Dis. 2024 Dec 20:ard-2024- 225982. doi: 10.1136/ard-2024-225982.
46. Ytterberg SR, Bhatt DL, Mikuls TR, et al. Cardiovascular and Cancer Risk with Tofacitinib in Rheumatoid Arthritis. N Engl J Med. 2022 Jan 27;386(4):316-326. doi: 10.1056/NEJMoa2109927.
47. Raaschou P, Simard JF, Holmqvist M, Askling J; ARTIS Study Group. Rheumatoid arthritis, anti-tumour necrosis factor therapy, and risk of malignant melanoma: nationwide population based prospective cohort study from Sweden. BMJ. 2013 Apr 8:346:f1939. doi: 10.1136/bmj.f1939.
48. Raaschou P, Frisell T, Askling J; ARTIS Study Group. TNF inhibitor therapy and risk of breast cancer recurrence in patients with rheumatoid arthritis: a nationwide cohort study. Ann Rheum Dis. 2015 Dec;74(12):2137-43. doi: 10.1136/annrheumdis-2014-205745.
49. Phillips C, Zeringue AL, McDonald JR, et al. Tumor Necrosis Factor Inhibition and Head and Neck Cancer Recurrence and Death in Rheumatoid Arthritis. PLoS One. 2015 Nov 23;10(11):e0143286. doi: 10.1371/journal.pone.0143286.
50. Hsu CY, Lin SH, Su YJ, et al. The risk of cardiovascular events following treatment for psoriatic arthritis with a biological agent. Rheumatology (Oxford). 2025 Oct 13:keaf487. doi: 10.1093/rheumatology/keaf487.
51. Avouac J, Ait-Oufella H, Habauzit C, et al. The Cardiovascular Safety of Tumour Necrosis Factor Inhibitors in Arthritic Conditions: A Structured Review with Recommendations. Rheumatol Ther. 2025 Apr;12(2): 211-236. doi: 10.1007/s40744-025-00753-x.
52. Jiang Y, Chen Y, Yu Q, Shi Y. Biologic and Small-Molecule Therapies for Moderateto-Severe Psoriasis: Focus on Psoriasis Comorbidities. BioDrugs. 2023 Jan;37(1):35-55. doi: 10.1007/s40259-022-00569-z.
53. Li J, Xiang X, Wang Z, et al. Safety of Interleukin Inhibitors in Psoriatic Patients with Latent Tuberculosis Infection Without Chemoprophylaxis: A Systematic Review. Acta Derm Venereol. 2025 Mar 3:105:adv42081. doi: 10.2340/actadv.v105.42081.
54. Crowley J, Thaci D, Joly P, et al. Longterm safety and tolerability of apremilast in patients with psoriasis: Pooled safety analysis for 156 weeks from 2 phase 3, randomized, controlled trials (ESTEEM 1 and 2). J Am Acad Dermatol. 2017 Aug;77(2):310-317.e1. doi: 10.1016/j.jaad.2017.01.052.
55. Crowley JJ, Warren RB, Cather JC. Safety of selective IL-23p19 inhibitors for the treatment of psoriasis. J Eur Acad Dermatol Venereol. 2019 Sep;33(9):1676-1684. doi: 10.1111/jdv.15653.
56. Torres T, Chiricozzi A, Puig L, et al. Treatment of Psoriasis Patients with Latent Tuberculosis Using IL-17 and IL-23 Inhibitors: A Retrospective, Multinational, Multicentre Study. Am J Clin Dermatol. 2024 Mar; 25(2):333-342. doi: 10.1007/s40257-024-00845-4.
57. Zhang Z, Fan W, Yang G, et al. Risk of tuberculosis in patients treated with TNF-α antagonists: a systematic review and metaanalysis of randomised controlled trials. BMJ Open. 2017 Mar 22;7(3):e012567. doi: 10.1136/bmjopen-2016-012567.
58. Cantini F, Nannini C, Niccoli L, et al. Guidance for the management of patients with latent tuberculosis infection requiring biologic therapy in rheumatology and dermatology clinical practice. Autoimmun Rev. 2015 Jun;14(6):503-9. doi: 10.1016/j.autrev. 2015.01.011.
59. Myers B, Thibodeaux Q, Reddy V, et al. Biologic Treatment of 4 HIV-Positive Patients: A Case Series and Literature Review. J Psoriasis Psoriatic Arthritis. 2021 Jan;6(1): 19-26. doi: 10.1177/2475530320954279.
60. Saeki H, Ito T, Hayashi M, et al. Successful treatment of ustekinumab in a severe psoriasis patient with human immunodeficiency virus infection. J Eur Acad Dermatol Venereol. 2015 Aug;29(8):1653-5. doi: 10.1111/jdv.12531.
61. Gridneva GI, Belov BS, Aronova ES. Chronic hepatitis B in rheumatic diseases: issues of infection screening and reactivation. Terapevticheskii arkhiv. 2024;96(5):523-530. (In Russ.).
62. Kuo MH, Ko PH, Wang SzTs, et al. Incidence of HBV Reactivation in Psoriasis Patients Undergoing Cytokine Inhibitor Therapy: A Single-Center Study and Systematic Review with a Meta-Analysis. Viruses. 2024 Dec 30; 17(1):42. doi: 10.3390/v17010042.
Review
For citations:
Lila AM, Korotaeva TV, Kruglova LS, Loginova EY, Korsakova YL, Gubar EE, Patrikeeva IM, Shesternya PA, Mutovina ZY, Zagrebneva AI, Vinogradova IB, Samigullina RR, Yakupova SP, Panevin TS, Khairutdinov VR, Bakulev AL, Pereverzina NO, Shatokhina EA, Murashkin NN, Khotko AA, Rudneva NS, Vladimirova IS, Sidorenko OA, Sergeeva IG, Vinnik YY, Gorodnichev PV, Khismatullina ZR. Russian interdisciplinary consensus on the definitions of “difficult-to-manage” and “difficult-to-treat” psoriatic arthritis/psoriasis and the management of these patients. Sovremennaya Revmatologiya=Modern Rheumatology Journal. 2026;20(3):108-119. (In Russ.) https://doi.org/10.14412/1996-7012-2026-3-108-119
JATS XML




































