Biological gene therapy for psoriasis: more than just skin clearance

Psoriasis is recognized as a systemic inflammatory disease, significantly affecting all major aspects of patients’ health, requiring a timely comprehensive approach to treatment. This approach should improve the overall well-being of patients and consider the psychosocial aspects of their lives. Special attention in modern research is given to psoriatic arthritis (PsA), which affects up to 30% of patients with psoriasis. There is growing interest in the possibility of stopping the progression of the psoriatic process and preventing the manifestation of PsA. Recent studies have shown that timely treatment with genetically engineered biological agents (biologics) can halt disease progression and prevent the development of disabling complications. The article discusses key clinical and immunological markers that can predict the development of PsA, opening pathways for earlier and targeted therapy. Special attention is given to the role of guselkumab, a monoclonal antibody targeting interleukin-23, in preventing the development of PsA in high-risk patients. Clinical observations of three patients with psoriasis treated with guselkumab showed not only complete skin clearance (PASI 0) but also positive changes in all major parameters of psoriasis severity, sustained remission of the skin process, and positive dynamics of manifestations of psoriatic onychodystrophy, which is currently considered the main predictor of PsA. These results indicate suppression of systemic inflammation and control of disease progression risk. The significant overall improvement in patient condition, along with the key indicator of therapy effectiveness – improved quality of life emphasizes the importance and efficacy of timely initiation of targeted therapy in patients with psoriasis with certain aggravating factors.