THE USE OF BIOCHEMICAL MARKERS IN PSORIASIS: C-REACTIVE PROTEIN, ESR, TNF- α, AND INTERLEUKIN-17

SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 121 THE USE OF BIOCHEMICAL MARKERS IN PSORIASIS: CREACTIVE PROTEIN, ESR, TNFα, AND INTERLEUKIN-17 S.A. Khan-Khodjaeva Tashkent State Medical University, Tashkent, Uzbekistan https://doi.org/10.5281/zenodo.17461344 Abstract. Psoriasis is a skin disease characterized by inflammation and an autoimmune nature. The role of various biochemical markers of inflammation, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and proinflammatory cytokines such as TNF-α and interleukin-17 (IL-17), is currently being actively studied. These markers provide insight into the inflammatory response, the severity of the disease, and can be used to assess the effectiveness of treatment. This article analyzes the role of biochemical markers in the comprehensive assessment of psoriasis, including determining its activity and severity, as well as prognosis and research. Recently, researchers have focused on studying biomarkers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), TNF-α, and interleukin 17 (IL-17), which play a key role in the pathogenesis of inflammation in this disease. Empirical data demonstrating a correlation between increased concentrations of these markers and disease progression are discussed, as well as their application in clinical practice for assessing therapeutic efficacy. The article emphasizes the need for further research to further elucidate the clinical significance of these biomarkers and their integration into personalized psoriasis treatment protocols. Keywords: biochemical markers, C-reactive protein, psoriasis, erythrocyte sedimentation rate, TNF-α, interleukin IL-17. Introduction It is widely recognized in the academic community that psoriasis is a chronic immuneassociated disease of multifactorial origin with a predominantly genetic component. It is characterized by keratinocyte hyperproliferation, impaired differentiation, immune reactions in the dermis and synovium, an imbalance between proinflammatory and anti-inflammatory cytokines and chemokines, and frequent pathological changes in the musculoskeletal system. The findings indicate that biochemical indicators of inflammatory processes are increasingly playing a role in better understanding the severity of psoriasis, predicting complications, and assessing the effectiveness of therapy [2,5,7,10]. The prevalence of psoriasis in the general population worldwide ranges from 2 to 3%. In different countries, these rates vary from 0.09 to 11.4% depending on the age of the patients, region of residence, and genetic factors. In Europe, psoriasis affects approximately 14 million people (Sommer R. et al., 2018). Chronic psoriasis accounts for over 90% of all cases (Griffiths C.E., Barker J.N., 2007). Approximately one-third of patients experience a recurrent course of the disease, ranging from moderate to severe. Although the causes of psoriasis are not fully understood, recognized risk factors include family history and environmental factors such as smoking, stress, obesity, and alcohol consumption (Huerta C. et al., 2007). It should be noted that the overall incidence of psoriasis between urban and rural residents differs significantly less than the primary incidence [1,3,4,6]. This may be due to the fact that only the most severe cases, which require extensive medical interventions and more frequent visits to SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 122 the doctor, are detected in rural areas. These differences are likely due to the lower treatment effectiveness in rural health care facilities and the unavailability of modern, highly effective medications (Mishina O.S., 2015). Biomarkers are specific properties that can be measured and interpreted as indicators of normal biological activity, disease states, or responses to external factors, including therapeutic interventions [3,9]. Biomarkers are widely used in various fields of medicine [7,11,12]. It is widely acknowledged that numerous studies have shown that patients with psoriasis are at increased risk of obesity, cardiovascular disease, and metabolic syndrome (Tollefson M.M. et al., 2010; Wu J.J. et al., 2015). The severity of psoriasis can be assessed not only by clinical parameters but also by biochemical markers. Some of these can reflect inflammatory processes, oxidative stress, or aspects of psoriasis pathogenesis. These markers include: 1. C-reactive protein (CRP) is an acute-phase reactant protein synthesized by hepatocytes in response to inflammatory stimuli. It is an indicator of inflammatory processes and tissue damage. Blood CRP concentrations rapidly increase in infectious diseases, traumatic injuries, autoimmune disorders, and other pathological conditions. In clinical practice, CRP levels are used in diagnostics, assessing inflammatory activity, and evaluating the effectiveness of therapy using biological agents (TNF-α and IL-17 inhibitors) [6,13,14,20]. 2. ESR (erythrocyte sedimentation rate) is a nonspecific laboratory test reflecting the erythrocyte sedimentation rate. ESR is an indirect indicator of infectious, inflammatory, and other pathological processes in the body [6,15,17,19]. 3. Cytokines play a key role in the pathogenesis of psoriasis: - Tumor necrosis factor alpha (TNF-α) is a central link in the immunological mechanisms underlying psoriasis. Patients with psoriasis have elevated levels of TNF-α in the skin and circulating blood. This stimulates keratinocytes, which, in turn, enhances the inflammatory response. TNF-α blocking agents have demonstrated high efficacy in the treatment of moderate to severe psoriasis. - Interleukin-6 (IL-6) - these cytokines can be elevated in the blood plasma of patients with severe psoriasis and influence inflammation [8,16]. - Interleukin-17 (IL-17). IL-17 is one of the key cytokines involved in the pathogenesis of psoriasis. Its serum concentration is directly related to the severity of the skin process. Modern biological agents (secukinumab, ixekizumab) are aimed at blocking IL-17 and provide a rapid reduction in inflammatory activity. Measuring IL-17 levels is considered a promising method for monitoring disease severity and response to therapy [1,2,8]. 4. Vitamin D - patients with psoriasis often have vitamin D deficiency, which can lead to deterioration of the skin condition and increased inflammation [4]. 5. Oxidative markers—for example, malondialdehyde (MDA), which is a product of lipid peroxidation. High MDA levels indicate the presence of oxidative stress, which plays an important role in the pathogenesis of psoriasis [12,18]. 6. Vascular endothelial growth factor (VEGF) is a molecule involved in angiogenesis (the formation of new blood vessels), and its levels may be elevated in psoriasis [7]. 7. Homocysteine—homocysteine levels may be elevated in patients with psoriasis, which may be associated with the risk of cardiovascular disease, which occurs in patients with psoriasis [6]. Research has consistently demonstrated that some of these markers can be used in clinical practice to assess disease activity, monitor treatment, and predict psoriasis-related risks. However, SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 123 a definitive assessment of psoriasis severity often requires a comprehensive approach, including clinical scales (e.g., the psoriasis area severity index PASI) and laboratory tests. Research methods. The study included research articles using databases such as PubMed, ResNet, eLibrary, Scopus, and Web of Science. The search was conducted using the Englishlanguage keywords "psoriasis" and "biomarkers," which identified relevant studies on biochemical markers in psoriasis. Research results. According to a study by Tan M. and colleagues, patients with psoriasis were more likely to experience symptoms of depression and anxiety than healthy individuals. More than half (50.2%) of patients with psoriasis reported depression, compared to 26.8% of the control group. Anxiety was observed in 39.7% of patients with psoriasis, compared to 17.6% of the healthy group. The study also found a link between inflammation and depression in patients with psoriasis. Elevated levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were associated with a higher likelihood of developing depression. CRP values above 3 mg/L and ESR values above 21 mm/h were found to indicate an increased risk of depression in patients with psoriasis. It is important to emphasize that the study highlights that psoriasis is often accompanied by psychological problems such as depression and anxiety. Furthermore, it highlights the role of inflammation in the development of depression in patients with psoriasis, which may be useful for improving diagnosis and treatment. Measuring CRP and ESR may help identify psoriasis patients at risk of depression [2,3,13,14,15]. There is substantial evidence to suggest that study by OvcinaKurtovic N. and colleagues examined serum tumor necrosis factor-alpha (TNF-α) levels in 60 patients with psoriasis and 20 healthy controls. Psoriasis patients were classified according to the clinical form of the disease: chronic plaque psoriasis (CPP), erythroderma, pustular psoriasis, and psoriatic arthritis. Blood samples were collected from all participants, including controls, to determine TNF-α levels using an enzyme-linked immunosorbent assay (ELISA). CPP severity was assessed using the PASI index. The results showed that serum TNF-α levels were significantly higher in patients with psoriasis than in healthy controls (3.25 ± 1.74 pg/ml versus 0.20 ± 0.01 pg/ml). The highest TNF-α values were observed in patients with pustular psoriasis (7.39±6.92 pg/ml). Statistically significant differences in TNF-α levels were found between different clinical forms of psoriasis (p<0.05). The average PASI score in patients with CKD was 0.56±12.45; however, the correlation between serum TNF-α levels and PASI in this group of patients was not statistically significant (p>0.05). The research results demonstrated the importance of determining serum TNF-α levels in patients with psoriasis. Additional studies are needed to further elucidate the pathogenic role and clinical significance of TNF-α, which may provide data for the development of new therapeutic strategies for patients with psoriasis [10,11,17,19,20]. It is imperative to recognize that research conducted by Mosca M. et al. identified the IL-17 axis as a key proinflammatory mediator involved in immune dysregulation. They describe in detail the broad proinflammatory effects of IL-17 cytokines, providing insight into their role in the pathogenesis of psoriasis and various associated diseases. Significant improvement in skin manifestations in psoriasis patients treated with novel IL-17 inhibitors underscores the importance of this axis in the immune mechanisms underlying psoriasis. Furthermore, the synergistic and cumulative effects of IL-17 cytokines in psoriasis pathogenesis are noteworthy, supporting the concept of therapy aimed at inhibiting multiple IL-17 isoforms. SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 124 Brodalumab, a human monoclonal antibody against the IL-17A receptor, is the only FDAapproved drug that inhibits multiple IL-17 cytokines, but bimekizumab, a monoclonal antibody against IL-17A and IL-17F, is also under investigation. Comparing the clinical efficacy of the drugs without head-to-head studies is difficult; patients treated with bimekizumab generally have higher PASI scores. The increased efficacy of dual inhibition therapy is one of the proposed benefits of neutralizing multiple IL-17 cytokines in the treatment of plaque psoriasis. Future studies should focus on the potential benefits of targeting IL-17C and IL-17E, given their role in enhancing inflammatory feedback and recruiting innate immune cells. Overall, future studies may focus on the effects of IL-17 cytokines on psoriasis comorbidities, the psoriasis inflammatory cascade, and responses to targeted therapies [8]. Conclusion In conclusion, it has been rigorously proven that the data presented in this article highlight the importance of biochemical markers such as CRP, ESR, TNF-α, and interleukins (particularly IL-17) in assessing psoriasis severity. Elevated levels of CRP and ESR, as well as cytokine imbalances such as TNF-α and IL-17, are clearly associated with inflammation and disease severity, making them promising markers for monitoring psoriasis activity and assessing the effectiveness of treatment. Research suggests that these molecules may serve not only as indicators of disease activity but also as potential therapeutic strategies for modulating inflammatory processes. It is necessary to highlight the fact that significant progress in the field of psoriasis biomarkers, further research is needed to accurately determine their clinical significance and implement them into routine practice. Furthermore, it is important to continue long-term patient follow-up to refine their prognostic value and improve personalized psoriasis treatment strategies. These biomarkers may play a key role in earlier identification of patients susceptible to disease progression and in reducing the risk of developing comorbidities. REFERENCES 1. Kokhan, M.M., Ivanov, A.A. The Role of Inflammatory Cytokines in the Pathogenesis of Psoriasis // Russian Journal of Skin and Venereal Diseases. - 2022. - Vol. 25, No. 3. - Pp. 4552. 2. Gavrilova, O.A. C-reactive protein and ESR as markers of systemic inflammation in patients with psoriasis // Clinical Dermatology and Venereology. - 2021. - Vol. 20, No. 4. - Pp. 67-73. 3. Elmets, C.A., Leonardi, C.L., Davis, D.M.R. et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics // Journal of the American Academy of Dermatology. – 2019. – Vol. 80, No. 4. – P. 1029–1072. 4. Blauvelt, A., Chiricozzi, A. The immunological role of IL-17 in psoriasis and psoriatic arthritis pathogenesis // Clinical Reviews in Allergy & Immunology. – 2018. – Vol. 55, no. 3. – P. 379–390. 5. Nestle, F.O., Kaplan, D.H., Barker, J. Psoriasis // N Engl J Med. – 2009. – Vol. 361. – P. 496– 509. 6. Boehncke, W.-H., Schön, M.P. Psoriasis // Lancet. – 2015. – Vol. 386, No. 9997. – P. 983– 994. 7. Dand N, Mahil SK, Capon F, Smith CH, Simpson MA, Barker JN. Psoriasis and Genetics. Acta Derm Venereol. 2020;100(3):adv00030. Published 2020 Jan 30. doi:10.2340/000155553384 SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 125 8. Davidovici BB, Sattar N, Prinz J, et al. Psoriasis and systemic inflammatory diseases: potential mechanistic links between skin disease and co-morbid conditions [published correction appears in J Invest Dermatol. 2010 Oct;130(10):2517. Jörg, Prinz C [corrected to Prinz, Jörg C]]. J Invest Dermatol. 2010;130(7):1785-1796. doi:10.1038/jid.2010.103 9. Food and Drug Administration, & National Institutes of Health. (2016). BEST (Biomarkers, Endpoints, and other tools) resource. Silver Spring, MD: FDA-NIH Biomarker Working Group. 10. Formisano E, Proietti E, Borgarelli C, Pisciotta L. Psoriasis and Vitamin D: A Systematic Review and Meta-Analysis. Nutrients. 2023;15(15):3387. Published 2023 Jul 30. doi:10.3390/nu15153387 11. Griffiths CEM, Armstrong AW, Gudjonsson JE, Barker JNWN. Psoriasis. Lancet. 2021;397(10281):1301-1315. doi:10.1016/S0140-6736(20)32549-6 12. Lin X, Meng X, Song Z. Homocysteine and psoriasis. Biosci Rep. 2019;39(11):BSR20190867. doi:10.1042/BSR20190867 13. Marina ME, Roman II, Constantin AM, Mihu CM, Tătaru AD. VEGF involvement in psoriasis. Clujul Med. 2015;88(3):247-252. doi:10.15386/cjmed-494 14. Mosca M, Hong J, Hadeler E, Hakimi M, Liao W, Bhutani T. The Role of IL-17 Cytokines in Psoriasis. Immunotargets Ther. 2021;10:409-418. Published 2021 Nov 24. doi:10.2147/ITT.S240891 15. Mussi A, Bonifati C, Carducci M, et al. Serum TNF-alpha levels correlate with disease severity and are reduced by effective therapy in plaque-type psoriasis. J Biol Regul Homeost Agents. 1997;11(3):115-118. 16. Ovcina-Kurtovic N, Kasumagic-Halilovic E. Serum Levels of Tumor Necrosis Factor - alpha in Patients With Psoriasis. Mater Sociomed. 2022;34(1):40-43. doi:10.5455/msm.2022.33.4043 17. Parisi R, Iskandar IYK, Kontopantelis E, et al. National, regional, and worldwide epidemiology of psoriasis: systematic analysis and modeling study. BMJ. 2020;369:m1590. Published 2020 May 28. doi:10.1136/bmj.m1590 18. Skoie IM, Dalen I, Omdal R, Jonsson G. Malondialdehyde and advanced oxidation protein products are not increased in psoriasis: a controlled study. Arch Dermatol Res. 2019;311(4):299-308. doi:10.1007/s00403-019-01903-2 19. Tan M, Luo Y, Hu J, et al. Elevated C-Reactive Protein and Erythrocyte Sedimentation Rate Correlates with Depression in Psoriasis: A Chinese Cross-Sectional Study. Clin Cosmet Investig Dermatol. 2023;16:397-405. Published 2023 Feb 13. doi:10.2147/CCID.S401934 20. Takeshita, J., Grewal, S., Langan, S.M. et al. Psoriasis and comorbid diseases: Epidemiology // J Am Acad Dermatol. – 2017. – Vol. 76. – P. 377–390.