Psoriatic arthritis: Strategies for challenging cases. Case report

This clinical case demonstrates a severe, highly active form of psoriatic arthritis with pronounced peripheral arthritis, dactylitis, enthesitis, and widespread skin lesions. The patient had radiographically confirmed signs of sacroiliitis, spondylitis, and significant structural changes (stage III–IV according to the Steinbrocker classification). The course of the disease was complicated by multiple comorbid conditions, including metabolic syndrome with morbid obesity (BMI 46 kg/m²), hyperuricemia, and subsequently clinically established diabetes insipidus. An additional factor that significantly limited the effectiveness of treatment was the patient's low adherence to therapy and repeated refusals to undergo the recommended examinations by related specialists. There was marked resistance of the disease to both the maximum tolerable doses of basic anti-inflammatory drugs and various groups of genetically engineered biological therapies. Despite repeated attempts to optimise treatment, it was not possible to achieve sustained control of the disease: only partial effectiveness of therapy was recorded, accompanied by periodic exacerbations and persistent high activity of the pathological process.