Abstract
BACKGROUND: Psoriatic arthritis (PsA) is a multi-domain inflammatory disease affecting skin, nails and the musculoskeletal system, often accompanied by comorbidities that complicate the management of patients. Although several biologic therapies have demonstrated efficacy, real world data for their use in difficult to manage PsA cases is limited. Bimekizumab, a dual interleukin-17A/F inhibitor, offers a promising option in such patients. CASE PRESENTATION: We report three challenging PsA cases treated effectively with bimekizumab. The first case involved a woman with isolated axial PsA presenting as inflammatory cervical pain, who achieved remission after intolerance to adalimumab. The second concerned a man with severe psoriasis and morbid obesity, who achieved rapid and sustained remission. The third case refers to a man with refractory PsA, multiple comorbidities and failure of several biologic and targeted therapies. Bimekizumab achieved complete remission of joint and skin manifestations in all three cases. CONCLUSION: These real-world cases support the efficacy and tolerability of bimekizumab across diverse and complex PsA presentations. Dual IL-17A/F inhibition may provide a valuable therapeutic option for patients with refractory disease, comorbidities, or rare phenotypes.