PO:05:074 | A clinical case of a patient affected by long-standing psoriatic arthritis and multiple comorbidities treated with an anti-IL-23 therapy

Maria Letizia Currò¹, Angelo Tropea¹, Alessandra Burgio¹, Francesca Cracò¹, Antonio Pezzano¹, Federica Rapisarda¹, Antonino Palumbo¹, Valeria D'Amico¹, Fabiola Atzeni¹ | ¹Clinica Reumatologica di Udine, Dipartimento di Medicina, ASUFC, Udine, Italy

Background. We describe the case of a patient affected by long-standing psoriatic arthritis, multiple joint deformities, and erythrodermic psoriasis, who was treated with an anti-IL-23 agent as first-line therapy.

Materials and Methods. A 58-year-old patient, living below the poverty line, unemployed since the onset of joint symptoms, underweight (BMI 14.9 kg/m²), smoker (20 pack-years), with previous HBV and HCV infections, affected by chronic kidney disease (stage II) and depressive syndrome, presented to our clinic in March 2024 because of multiple joint pain and swelling, functional limitations, erythema, and desquamation involving the entire body surface. He reported that he had never been treated until then.

Results. Physical examination and clinometric evaluation showed a PASI score of 39.2 and a DAPSA score of 55.9. Laboratory tests revealed red blood cells 3,180,000/mm³, hemoglobin 9.7 g/dL, white blood cells 15,800/mm³, neutrophils 74%, lymphocytes 16%, platelets 737,000/mm³, creatinine 1.8 mg/dL, uric acid 8.3 mg/dL, ESR 120 mm/h, and CRP 7.9 mg/dL. Radiographs of the hands and feet showed multiple deformities (ankylosis, erosions, and bone proliferation). A diagnosis of long-standing polyarticular psoriatic arthritis, erythrodermic psoriasis, and probable reactive thrombocytosis was made. In April 2024, lamivudine prophylaxis was started to prevent HBV reactivation, and in June 2024, therapy with an anti-IL-23 drug was initiated. At the follow-up visit in September 2024, the patient reported improvement in osteoarticular and cutaneous symptoms; clinometric indexes showed PASI 28.6 and DAPSA 24.6. Laboratory tests revealed white blood cells 9.0 × 10³/μL, neutrophils 50.5%, lymphocytes 33.2%, red blood cells 3.13 × 10 /μL, hemoglobin 10.8 g/dL, platelets 530 × 10³/μL, creatinine 1.40 mg/dL, uric acid 6.1 mg/dL, CRP 3.6 mg/dL, and ESR 113 mm/h. During follow-up, the clinical picture remained stable, without viral reactivation, new infections, worsening of renal involvement, and with improvement in depressive symptoms.

Conclusions. The clinical case we present shows the efficacy and safety of anti-IL-23 therapy in a patient with long-standing disease and multiple comorbidities.