Bridging the Gap: Characterizing Complex Immune-Mediated Inflammatory Diseases with Cutaneous Manifestations

Area of Science:

• Immunology
• Dermatology
• Rheumatology

Background:

• Coexistence of multiple immune-mediated inflammatory diseases (IMIDs) presents a growing clinical challenge.
• Limited data exists for patients managing more than two IMIDs concurrently.

Purpose of the Study:

• To characterize clinical profiles, treatment responses, and quality of life in patients with complex IMID associations.
• Focus on IMIDs involving cutaneous manifestations.

Main Methods:

• Established the CIMID-Skin registry, a prospective observational study.
• Adult patients with multiple IMIDs and at least one dermatological condition were enrolled.
• Stratified patients into control (2 IMIDs) and complex (≥3 IMIDs) groups, collecting clinical data, severity scores, and patient-reported outcomes.

Main Results:

• Cohort (n=54) predominantly female (77.8%), mean age 45.4 years, BMI 27.4 kg/m².
• 59.3% had ≥3 IMIDs; common conditions included psoriasis, hidradenitis suppurativa, and psoriatic arthritis.
• Significant paradoxical reactions (24.1% paradoxical psoriasis), impaired quality of life (65.2% moderate-to-extreme DLQI impact), and depression risk (24.1% WHO-5 threshold).

Conclusions:

• Complex IMID associations exhibit distinct clinical patterns and therapeutic challenges.
• High prevalence of paradoxical reactions and specific IMID clustering suggest shared pathophysiological mechanisms.
• Further investigation into these shared mechanisms is warranted.