The coach-patient collaboration occurs within seven modules. Table 1 describes these modules in detail. The transition to the next module typically occurs upon completion of the previous one. Combining modules M2, M3, and M4 is permitted. The collaboration may end earlier if stable remission of psoriatic disease (PsD) is achieved by the completion of one of the modules (M2, M3, M4, M6). For the same reason, the patient can independently formulate their own individual regime (IR), i.e., opt out of module M7.
Each Module may consist of several Phases. Each Phase (A, B, and C) contains three sequential subphases (Tables 2, 3, and 4).
Table 5 contains information on abbreviations and terms.
Table 1. Collaboration modules.
| Modules | Phases, timing and actions |
| M1. Start. Collecting primary information. Goal: Detailed information about health, PsD, and lifestyle. Also, information about SIBO treatments (if any). |
Phases A, B. Duration: 1–2 weeks. MiniGuide. Guide: Sections 1, 2, 3, 4, as well as 12 and 14. |
| M2. Overweight. This module is only available for overweight patients. Goal: Weight loss, PsD remission. |
Phases B, C. Duration: 4-12 weeks. Excess weight loss is achieved through a combination of measures, including diet, regular exercise, and, sometimes, medication. The duration of these measures and the achievement of the desired weight depends on the extent of excess weight. Modules M2, M3, and M4 can be combined. Source [1]. |
| M3. Diet. PPV. Goal: developing individualial diet with the exclusion (limited consumption) of foods containing potentially problematic substances (PPS), PsD remission. |
Phases A, B, C. Duration: • Up to 12 weeks. The final diet will be an elimination diet (i.e., some foods will be completely excluded from the diet). The maximum period is necessary to check sensitivity to glycoalkaloids (contained in nightshades). Sensitivity to other potentially problematic substances (gluten, lactose) is determined by tests. • Up to 36 weeks. The final diet will be with selectively limited consumption. The process of finding the daily “safety threshold” of the PPS takes much longer. But ultimately, it allows you to maintain a more varied diet. The final individual diet helps restore the small intestinal barrier (reduce the role of the factor of its increased permeability for bacterial products). Modules M2, M3, and M4 can be combined. Guide: Section 7. Source [1]. |
| M4. SIBO. Risk factors. Identification and elimination (reduction of intensity) of these factors. Goals: elimination (reduction of influence) of SIBO risk factors, PsD remission. |
Phases A, B, C. Duration: 2–4 weeks (diagnosis). If modifiable risk factors for SIBO are identified (e.g., chronic bacterial infection of the upper respiratory tract, Helicobacter pylori, or intestinal parasites), then 2–6 weeks are added for specialized treatment courses to eliminate them (reduce their intensity). Modules M2, M3, and M4 can be combined. Guide: Sections 5, 8, 9, and 10 (except 10.8, 10.9, and 10.10), 11. Source [2]. |
| M5. SIBO. Diagnostics. Diagnostics of SIBO, determination of contraindications for intestinal lavage. Goal: preparation for M6. |
Phases A, B. Duration: • 7-10 days – according to the “gold standard” (10.8, 10.9) – optimal. • 1 day – according to breath tests (10.10). Reliability 70-80%, there is no information on which bacteria cause SIBO, their spectrum, concentration and sensitivity are unknown. In the absence of diagnostic results according to the “gold standard”, it is possible to develop a universal treatment course. With the inclusion of several bacteriophages and/or broad-spectrum antibiotics. However, this reduces the likelihood of eliminating (significantly reducing the level) psoriagenic and enhancing bacteria. The need for subsequent courses of treatment for SIBO increases. Guide: Section 10 (10.8, 10.9 and 10.10), 13. Source [2]. |
| M6. SIBO. Treatment. Developing and implementing a treatment course for SIBO. Goals: eliminating (reducing) SIBO and achieving PsD remission. |
Phase C. Duration: up to 7 weeks. • 1-3 days: Analysis of diagnostic results and development of a treatment course. • 1-3 days: Purchase of medications (phages, antibiotics, antifungals, etc.). • 7-10 days: Treatment course for SIBO. • 3-5 days: Gradual withdrawal from the course. • 4 weeks: Waiting period for the final result on the skin. It is necessary to try to exclude all factors influencing psoriasis (medications, acute respiratory viral infections, poisoning, sunburn, dietary breakdowns). Only in this way will it be possible to objectively evaluate the effectiveness of the course. Guide: Section 14. Sources [2,3]. |
| M7. Individual Regime. Developing recommendations for a long-term individual regimen (IR). Goal: To establish and maintain stable, long-term PsD remission. |
Phase C. Long-term (6 months or more). Typically, IR consists of two individual plans (IP). For example: IP1 is a permanent, long-term plan (6 months or more). IP2 is short-term (one week of a fasting diet and cleansing procedures). IP2 replaces IP1 for one week twice a year (e.g., in spring and fall). The coach remains available in case of relapses or force majeure. Guide: 12 and 14 (additional subsections). |
Table 2. Phase A. Interview and medical records (existing).
| A1. Coach. The coach defines the list of questions and medical documentation (within the Guide). |
| A2. Patient. The patient provides information about themselves, their health, and their lifestyle, according to a list of questions, and completes the required items of the Guide. Information on their current PASI status is accompanied by photographs of the most common areas. The patient collects existing medical documentation, including the results of previous tests, examinations, and medical reports, and completes the required items of the Guide, along with any accompanying medical documents (files, scans, or photos). If any documentation is missing, they indicate “no” in the corresponding item. |
| A3. Coach. The coach examines the information presented and may ask additional (clarifying) questions. |
| Note: Multiple iterations are possible (after A3, back to A2). This is because the information may be incomplete or require clarification. |
Table 3. Phase B. Medical documentation (new).
| B1. Coach. The coach determines the list of required documentation (usually within the Questionnaire). |
| B2. Patient. The patient completes and provides the results of new tests, examinations, and medical reports, completes the required items of the Guide, and attaches medical documents (files, scans, or photos). For example, information about the diagnosis, treatment (and results) for bacterial chronic upper respiratory tract infections (or Helicobacter pylori infection or intestinal parasites). If any documentation is unavailable, indicate “no” and describe the reason in the appropriate item of the Guide. |
| B3. Coach. The coach examines the information provided and may ask additional (clarifying) questions and/or supplement the list of required documentation. |
| Note: Multiple iterations are possible (after B3, B2 again). This is because the patient will need clarification from the coach while following recommendations and providing new medical documentation. This is because the information may be incomplete or require clarification. This is because new results may require additional tests, examinations, and medical opinions. |
Table 4. Phase C. Individual plan (IP).
| C1. Coach. The coach develops the IP (in dialogue with the patient). |
| C2. Patient. The patient performs the IP and provides its results, completing the required items of the Guide, along with diaries and medical documentation (files, scans, or photos). Information on PASI compliance is accompanied by photographs of the most characteristic areas during the IP period (at the beginning, during the period, at the end of the period, and several weeks after completion). |
| C3. Coach. The coach performs the information presented and may ask additional (clarifying) questions. |
| Note: Multiple iterations are possible (after C3, C2 again). Because information about the IP implementation may be incomplete or require clarification. Because the IP implementation did not lead to the desired results. Because the formation of the subsequent IP could not be completed until the results of this IP implementation were obtained. Because the IP implementation resulted in the need to obtain additional medical documentation (i.e., a transition to Phase B is possible). |
Table 5. Abbreviations and terms
| Abbreviation and term | Meaning and/or description |
| Guide | Psoriatic patient Guide |
| MiniGuide | A short initial list of questions. |
| IP | Individual plan. Lifestyle modification, diet trial, or treatment course. An individual plan has a recommended duration. It consists of several components (diet and meal plan, medications and/or procedures, exercise, sleep schedule, etc.). |
| IR | Individual regime. May consist of several consecutive IPs. Or it may be a permanent long-term IP1, sometimes replaced by a short-term IP2. |
| PsD | Psoriatic disease |
| PPV | Potentially problematic substances [1] |
| SIBO | Small intestinal bacterial overgrowth |
Sourses
[1] Individual Diet for Psoriatic Disease.
[2] SIBO – Detect and Eliminate!
[3] GIT cleansing with saline? Matkevich lavage is the first choice.