18 research outputs found
Diagnosis of spondyloarthritis: should we need new criteria?
A large number of classification criteria for spondyloarthritis (SpA) are simultaneously used in modern rheumatology in the almost complete absence of diagnostic criteria. This poses a number of problems, among which there are two most important ones: 1) the frequent use of classification criteria to make a diagnosis in real clinical practice; 2) the possibility of stating different nosological entities of SpA in one patient in the presence of the same clinical picture.Objective: to investigate the specific features of the diagnosis of SpA and the use of its classification criteria in clinical practice.Subjects and methods. The investigation enrolled 119 patients with the established diagnosis of ankylosing spondylitis (AS), psoriatic arthritis (PsA), undifferentiated axial or peripheral SpA. Whether their clinical picture complied with the modified New York criteria, the European Spondyloarthropathy Study Group (ESSG) criteria, the Amor criteria, and the Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axial and peripheral SpA and whether the Russian version of the modified New York criteria complied with the Classification criteria of Psoriatic ARthritis (CASPAR) were determined in the patients.Results. Sixty-three patients diagnosed with AS (M45), 44 with PsA (M07.0-07.3), 8 with undifferentiated SpA (M46.9), and 4 with nonradiographic axial SpA (M46.8) were followed up by attending physicians. The latter diagnosed AS in 10 patients who met the ASAS criteria for axial PsA but not the modified New York criteria. Twenty-one patients diagnosed as having PsA simultaneously met both the CASPAR criteria and the modified New York criteria, which could establish the diagnosis of AS in these cases. Eighty-one (68.0%) out of the 119 patients met the Amor criteria; 98 (82.3%) patients, the ESSG criteria; 91 (76.5%), the ASAS criteria for axial SpA; 18 (15.1%), the ASAS criteria for peripheral SpA; 76 (63.8%), the modified New York criteria; 88 (73.9%), the Russian version of the modified New York criteria; 42 (32.3%), the CASPAR criteria. No intersection of criteria was observed in only 5 patients; 113 (94.9%) patients met β₯2 criteria; 96 (80.7%), β₯3 criteria; 81 (68.1%), β₯4 criteria; 66 (55.5%), simultaneously β₯5 criteria; and 18 (15.1%), simultaneously 6 criteria.Conclusion. Most patients with SpA meet β₯2 classification criteria, which gives the chance to state β₯2 nosological entities in the same patient. This demonstrates the elaboration of diagnostic criteria that can make a clear distinction between different forms of SpA in clinical practice
ΠΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ Π°ΠΊΡΠΈΠ°Π»ΡΠ½ΡΡ ΡΠΏΠΎΠ½Π΄ΠΈΠ»ΠΎΠ°ΡΡΡΠΈΡΠΎΠ², Π²ΠΊΠ»ΡΡΠ°Ρ Π°Π½ΠΊΠΈΠ»ΠΎΠ·ΠΈΡΡΡΡΠΈΠΉ ΡΠΏΠΎΠ½Π΄ΠΈΠ»ΠΈΡ ΠΈ ΠΏΡΠΎΡΠΈΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΉ Π°ΡΡΡΠΈΡ, Ρ Π»ΠΈΡ ΡΠ°Π·Π½ΠΎΠ³ΠΎ ΠΏΠΎΠ»Π°
The increasing number of women with ankylosing spondyloarthritis (SpA) makes it relevant to study the specific features of this disease in persons of different genders.Objective: to study the indicators of activity and functional status in male and female patients with axial SpA.Subjects and methods. The study enrolled 91 patients (43 women and 48 men) with axial SpA admitted to the Rheumatology Unit of the Saratov Regional Clinical Hospital in 2013. The age of the women and men was 41.63Β±12.04 and 41.94Β±12.76 years, respectively. All the patients fulfilled the ASAS criteria for axial SpA. 60.43% of the patients had ankylosing spondylitis (AS) meeting the modified New York criteria; 26.37% had psoriatic arthritis (PsA) according to the CASPAR criteria (only patients with axial involvement were included in the study and those with peripheral arthritis were excluded); 9.89% had undifferentiated axial SpA. Age at symptom onset, disease duration, and age at diagnosis of axial SpA were taken into account. The activity of axial SpA (ASDAS, BASDAI, highsensitivity C-reactive protein) and the mobility of the axial skeleton (BASMI and its components) were investigated in patients of different genders.Results. The study has established that the women are hospitalized with diagnosed axial SpA as often as the men. The indicators of activity and axial skeleton mobility are similar in the male and female patients with axial SpA as a whole and with a disease history of less than 10 years. Having a disease history of more than 10 years, the women preserve greater mobility of the lumbar and cervical spine than do the men with the similar disease activity.Π£Π²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠ΅ ΡΠΈΡΠ»Π° ΠΆΠ΅Π½ΡΠΈΠ½ Ρ Π°ΠΊΡΠΈΠ°Π»ΡΠ½ΡΠΌ ΡΠΏΠΎΠ½Π΄ΠΈΠ»ΠΎΠ°ΡΡΡΠΈΡΠΎΠΌ (Π‘ΠΏΠ) Π΄Π΅Π»Π°Π΅Ρ Π°ΠΊΡΡΠ°Π»ΡΠ½ΡΠΌ ΠΈΠ·ΡΡΠ΅Π½ΠΈΠ΅ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠ΅ΠΉ ΡΡΠΎΠ³ΠΎ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ Ρ Π»ΠΈΡ ΡΠ°Π·Π½ΠΎΠ³ΠΎ ΠΏΠΎΠ»Π°.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΎΡΠ΅Π½ΠΊΠ° ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΈ ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ°ΡΡΡΠ° Ρ ΠΌΡΠΆΡΠΈΠ½ ΠΈ ΠΆΠ΅Π½ΡΠΈΠ½, ΡΡΡΠ°Π΄Π°ΡΡΠΈΡ
Π°ΠΊΡΠΈΠ°Π»ΡΠ½ΡΠΌ Π‘ΠΏΠ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠ΅Π½ 91 ΠΏΠ°ΡΠΈΠ΅Π½Ρ (43 ΠΆΠ΅Π½ΡΠΈΠ½Ρ ΠΈ 48 ΠΌΡΠΆΡΠΈΠ½) Ρ Π°ΠΊΡΠΈΠ°Π»ΡΠ½ΡΠΌ Π‘ΠΏΠ, Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΡΠΉ Π² ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΠ΅ ΡΠ΅Π²ΠΌΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ ΠΠ±Π»Π°ΡΡΠ½ΠΎΠΉ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»ΡΠ½ΠΈΡΡ (Π‘Π°ΡΠ°ΡΠΎΠ²) Π² 2013 Π³. ΠΠΎΠ·ΡΠ°ΡΡ ΠΆΠ΅Π½ΡΠΈΠ½ ΠΈ ΠΌΡΠΆΡΠΈΠ½ ΡΠΎΡΡΠ°Π²ΠΈΠ» ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ 41,63Β±12,04 ΠΈ 41,94Β±12,76 Π³ΠΎΠ΄Π°. ΠΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ ΠΎΡΠ²Π΅ΡΠ°Π»ΠΈ ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ ASAS Π΄Π»Ρ Π°ΠΊΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π‘ΠΏΠ. Π£ 60,43% ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΈΠΌΠ΅Π»ΡΡ Π°Π½ΠΊΠΈΠ»ΠΎΠ·ΠΈΡΡΡΡΠΈΠΉ ΡΠΏΠΎΠ½Π΄ΠΈΠ»ΠΈΡ (ΠΠ‘), ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΡΡΡΠΈΠΉ ΠΌΠΎΠ΄ΠΈΡΠΈΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΌ ΠΡΡ-ΠΠΎΡΠΊΡΠΊΠΈΠΌ ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ, Ρ 26,37% β ΠΏΡΠΎΡΠΈΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΉ Π°ΡΡΡΠΈΡ (ΠΡΠ), ΡΠΎΠ³Π»Π°ΡΠ½ΠΎ ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ CASPAR (Π² ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠ°Π»ΠΈ ΡΠΎΠ»ΡΠΊΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π°ΠΊΡΠΈΠ°Π»ΡΠ½ΡΠΌ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΠ΅ΠΌ ΠΈ ΠΈΡΠΊΠ»ΡΡΠ°Π»ΠΈ ΠΈΠ· Π½Π΅Π³ΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΏΠ΅ΡΠΈΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΈΠΌ Π°ΡΡΡΠΈΡΠΎΠΌ), Ρ 9,89% β Π½Π΅Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΉ Π°ΠΊΡΠΈΠ°Π»ΡΠ½ΡΠΉ Π‘ΠΏΠ. Π£ΡΠΈΡΡΠ²Π°Π»ΠΈ Π²ΠΎΠ·ΡΠ°ΡΡ ΠΏΠΎΡΠ²Π»Π΅Π½ΠΈΡ ΡΠΈΠΌΠΏΡΠΎΠΌΠΎΠ², Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ, Π²ΠΎΠ·ΡΠ°ΡΡ ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ Π΄ΠΈΠ°Π³Π½ΠΎΠ·Π° Π°ΠΊΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π‘ΠΏΠ. ΠΠ·ΡΡΠ΅Π½Π° Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ Π°ΠΊΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π‘ΠΏΠ (ΠΈΠ½Π΄Π΅ΠΊΡΡ ASDAS, BASDAI, Π²ΡΡΠΎΠΊΠΎΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΡΠΉ Π‘Π Π) ΠΈ ΠΏΠΎΠ΄Π²ΠΈΠΆΠ½ΠΎΡΡΡ ΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΡΠΊΠ΅Π»Π΅ΡΠ° (ΠΈΠ½Π΄Π΅ΠΊΡ BASMI ΠΈ Π΅Π³ΠΎ ΡΠΎΡΡΠ°Π²Π»ΡΡΡΠΈΠ΅) Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠ°Π·Π½ΠΎΠ³ΠΎ ΠΏΠΎΠ»Π°.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π Ρ
ΠΎΠ΄Π΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Π²ΡΡΡΠ½Π΅Π½ΠΎ, ΡΡΠΎ ΠΆΠ΅Π½ΡΠΈΠ½ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·ΠΈΡΡΡΡ Ρ Π΄ΠΈΠ°Π³Π½ΠΎΠ·ΠΎΠΌ Π°ΠΊΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π‘ΠΏΠ ΡΠ°ΠΊ ΠΆΠ΅ ΡΠ°ΡΡΠΎ, ΠΊΠ°ΠΊ ΠΈ ΠΌΡΠΆΡΠΈΠ½. ΠΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΈ ΠΏΠΎΠ΄Π²ΠΈΠΆΠ½ΠΎΡΡΠΈ Π°ΠΊΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠΊΠ΅Π»Π΅ΡΠ° Ρ ΠΌΡΠΆΡΠΈΠ½ ΠΈ ΠΆΠ΅Π½ΡΠΈΠ½ Ρ Π°ΠΊΡΠΈΠ°Π»ΡΠ½ΡΠΌ Π‘ΠΏΠ Π² ΡΠ΅Π»ΠΎΠΌ ΠΈ ΠΏΡΠΈ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΠΌΠ΅Π½Π΅Π΅ 10 Π»Π΅Ρ ΡΠΎΠΏΠΎΡΡΠ°Π²ΠΈΠΌΡ. ΠΡΠΈ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ Π±ΠΎΠ»Π΅Π΅ 10 Π»Π΅Ρ Ρ ΠΆΠ΅Π½ΡΠΈΠ½ ΡΠΎΡ
ΡΠ°Π½ΡΠ΅ΡΡΡ Π±ΠΎΠ»Π΅Π΅ Π²ΡΡΠΎΠΊΠ°Ρ ΠΏΠΎΠ΄Π²ΠΈΠΆΠ½ΠΎΡΡΡ ΠΏΠΎΡΡΠ½ΠΈΡΠ½ΠΎΠ³ΠΎ ΠΈ ΡΠ΅ΠΉΠ½ΠΎΠ³ΠΎ ΠΎΡΠ΄Π΅Π»ΠΎΠ² ΠΏΠΎΠ·Π²ΠΎΠ½ΠΎΡΠ½ΠΈΠΊΠ°, ΡΠ΅ΠΌ Ρ ΠΌΡΠΆΡΠΈΠ½, ΠΏΡΠΈ ΡΠΎΠΏΠΎΡΡΠ°Π²ΠΈΠΌΠΎΠΉ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ
ΠΠ΅ΡΡΠΊΠΎΡΡΡ ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ ΡΡΠ΅Π½ΠΊΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π°Π½ΠΊΠΈΠ»ΠΎΠ·ΠΈΡΡΡΡΠΈΠΌ ΡΠΏΠΎΠ½Π΄ΠΈΠ»ΠΈΡΠΎΠΌ, ΠΏΡΠΈΠ½ΠΈΠΌΠ°ΡΡΠΈΡ Π½Π΅ΡΡΠ΅ΡΠΎΠΈΠ΄Π½ΡΠ΅ ΠΏΡΠΎΡΠΈΠ²ΠΎΠ²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΡ
Changes in vessel wall stiffness are a sign of endothelial dysfunction and vascular remodeling at reversible, preclinical stages and may be aΒ marker for cardiovascular disease, including in the use of nonsteroidal anti-inflammatory drugs (NSAIDs).Objective: to study changes in vessel wall stiffness indicators in patients with active ankylosing spondylitis (AS) without cardiovascular diseasesΒ during short- and long-term therapy with NSAIDS.Patients and methods. The investigation enrolled 164 AS patients aged older than 18 years. Of them 60 patients took amtolmetin guacil (AMG)Β daily for 3 months within the framework of the CORONA trial, the other 104 patients received nimesulide at least thrice weekly for 60 monthsΒ (the index of NSAID use was 56%) within the framework of the PROGRESS study. Vessel wall stiffness indicators (augmentation indices andΒ aortic pulse wave velocity (PWVao)) were studied in all the patients at baseline and after 3 (for those who took AMG) and 60 (for those who receivedΒ nimesulde) months.Results. At baseline, AS activity and cardiovascular risk factors were comparable in the short- and long-term follow-up groups. The mean valuesΒ of aortic augmentation index (AixAo) in the patients taking AMG were 13.5% [6.08; 22.08] at baseline and 14.25% [9.4; 24.25] afterΒ 3 months of therapy (p=0.18); PWVao was 7.7 [6.72; 9.41] and 8.46 [7.28; 9.96] m/sec, respectively (p=0.007). At the same time, PWVao was >10 m/sec only in 6 (10%) patients at baseline and in 12 (20%) following 3 months. In the group of patients taking NSAIDs long, AixAo was 21.5% [11.08; 34.25] at baseline and 18.25% [09.33; 26.28] at week 12 (p=0.3); PWVao was as high as 7.6 [6.56; 7.91] at baseline and 7.8 [7.22; 8.1] m/sec at week 12 (p=0.12). The PWVao of >10 m/sec was found in 20 (19.2%) patients at baseline and in 22 (21.15%) after 60 months of follow-up and treatment. The number of patients with unidirectional changes in vessel wall stiffness indicators did not differ in the 3- and 60-month use of NSAIDs.Β Conclusion. During 3-month NSAID therapy, the patients with AS showed a slight increase in PWVao in the absence of changes in the otherΒ indicators of vessel wall stiffness. At the same time, the mean values of PWVao remained within the normal range and its increase >10 m/secΒ was detected only in 20% of the patients. Long-term NSAID therapy in AS patients without cardiovascular diseases was unaccompanied byΒ a change in the values of vessel wall stiffness and PWVao.ΠΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΠΆΠ΅ΡΡΠΊΠΎΡΡΠΈ ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ ΡΡΠ΅Π½ΠΊΠΈ ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΏΡΠΈΠ·Π½Π°ΠΊΠΎΠΌ Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΠΈ ΡΠ½Π΄ΠΎΡΠ΅Π»ΠΈΡ ΠΈ ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠ³ΠΎ ΡΠ΅ΠΌΠΎΠ΄Π΅Π»ΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π½Π° ΠΎΠ±ΡΠ°ΡΠΈΠΌΡΡ
, Π΄ΠΎΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΡΠ°ΠΏΠ°Ρ
ΠΈ ΠΌΠΎΠΆΠ΅Ρ Π±ΡΡΡ ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠΌ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΡ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎ-ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ ΡΠΈΡΡΠ΅ΠΌΡ, Π² ΡΠΎΠΌ ΡΠΈΡΠ»Π΅ ΠΏΡΠΈ ΠΏΡΠΈΠ΅ΠΌΠ΅ Π½Π΅ΡΡΠ΅ΡΠΎΠΈΠ΄Π½ΡΡ
ΠΏΡΠΎΡΠΈΠ²ΠΎΠ²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΡΡ
ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ² (ΠΠΠΠ).Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΈΠ·ΡΡΠ΅Π½ΠΈΠ΅ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΠΆΠ΅ΡΡΠΊΠΎΡΡΠΈ ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ ΡΡΠ΅Π½ΠΊΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π°ΠΊΡΠΈΠ²Π½ΡΠΌ Π°Π½ΠΊΠΈΠ»ΠΎΠ·ΠΈΡΡΡΡΠΈΠΌΒ ΡΠΏΠΎΠ½Π΄ΠΈΠ»ΠΈΡΠΎΠΌ (ΠΠ‘) Π±Π΅Π· ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎ-ΡΠΎΡΡΠ΄ΠΈΡΡΡΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ Π½Π° ΡΠΎΠ½Π΅ ΠΊΡΠ°ΡΠΊΠΎΡΡΠΎΡΠ½ΠΎΠΉ ΠΈ Π΄ΠΎΠ»Π³ΠΎΡΡΠΎΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΠΠΠ.ΠΠ°ΡΠΈΠ΅Π½ΡΡ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠ΅Π½ΠΎ 164 Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΠ‘ ΡΡΠ°ΡΡΠ΅ 18 Π»Π΅Ρ. ΠΠ· Π½ΠΈΡ
60 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π² ΡΠ°ΠΌΠΊΠ°Ρ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡΒ ΠΠΠ ΠΠΠ Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ 3 ΠΌΠ΅Ρ Π΅ΠΆΠ΅Π΄Π½Π΅Π²Π½ΠΎ ΠΏΡΠΈΠ½ΠΈΠΌΠ°Π»ΠΈ Π°ΠΌΡΠΎΠ»ΠΌΠ΅ΡΠΈΠ½ Π³ΡΠ°ΡΠΈΠ» (ΠΠΠ), ΠΎΡΡΠ°Π»ΡΠ½ΡΠ΅ 104 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Π² ΡΠ°ΠΌΠΊΠ°Ρ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡΒ ΠΠ ΠΠΠ ΠΠ‘Π‘ ΠΏΠΎΠ»ΡΡΠ°Π»ΠΈ Π½ΠΈΠΌΠ΅ΡΡΠ»ΠΈΠ΄ Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ 60 ΠΌΠ΅Ρ Π½Π΅ ΠΌΠ΅Π½Π΅Π΅ 3 ΡΠ°Π· Π² Π½Π΅Π΄Π΅Π»Ρ (ΠΈΠ½Π΄Π΅ΠΊΡ ΠΏΡΠΈΠ΅ΠΌΠ° ΠΠΠΠ ΡΠΎΡΡΠ°Π²ΠΈΠ» 56%). Π£ Π²ΡΠ΅Ρ
Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΈΠ·ΡΡΠ°Π»ΠΈ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ ΠΆΠ΅ΡΡΠΊΠΎΡΡΠΈ ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ ΡΡΠ΅Π½ΠΊΠΈ (ΠΈΠ½Π΄Π΅ΠΊΡΡ Π°ΡΠ³ΠΌΠ΅Π½ΡΠ°ΡΠΈΠΈ ΠΈ ΡΠΊΠΎΡΠΎΡΡΡ ΠΏΡΠ»ΡΡΠΎΠ²ΠΎΠΉ Π²ΠΎΠ»Π½Ρ Π² Π°ΠΎΡΡΠ΅ β PWVAo) ΠΈΡΡ
ΠΎΠ΄Π½ΠΎ,Β ΡΠ΅ΡΠ΅Π· 3 ΠΌΠ΅Ρ (Π΄Π»Ρ ΠΏΠΎΠ»ΡΡΠ°Π²ΡΠΈΡ
ΠΠΠ) ΠΈ ΡΠ΅ΡΠ΅Π· 60 ΠΌΠ΅Ρ (Π΄Π»Ρ ΠΏΠΎΠ»ΡΡΠ°Π²ΡΠΈΡ
Π½ΠΈΠΌΠ΅ΡΡΠ»ΠΈΠ΄).Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΡΡ
ΠΎΠ΄Π½ΠΎ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΠΠ‘, ΡΠ°ΠΊΡΠΎΡΡ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎ-ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° Π² Π³ΡΡΠΏΠΏΠ°Ρ
ΠΊΡΠ°ΡΠΊΠΎΡΡΠΎΡΠ½ΠΎΠ³ΠΎ ΠΈ Π΄ΠΎΠ»Π³ΠΎΡΡΠΎΡΠ½ΠΎΠ³ΠΎ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ Π±ΡΠ»ΠΈ ΡΠΎΠΏΠΎΡΡΠ°Π²ΠΈΠΌΡ. ΠΡΡ
ΠΎΠ΄Π½ΠΎ ΡΡΠ΅Π΄Π½ΠΈΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΡ ΠΈΠ½Π΄Π΅ΠΊΡΠ° Π°ΡΠ³ΠΌΠ΅Π½ΡΠ°ΡΠΈΠΈ Π² Π°ΠΎΡΡΠ΅ (AixAo) Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΏΡΠΈΠ½ΠΈΠΌΠ°Π²ΡΠΈΡ
ΠΠΠ, ΡΠΎΡΡΠ°Π²Π»ΡΠ»ΠΈ 13,5% [6,08; 22,08], ΡΠ΅ΡΠ΅Π· 3 ΠΌΠ΅Ρ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ β 14,25% [9,4; 24,25] (p=0,18); PWVAo β 7,7 ΠΌ/Ρ [6,72; 9,41] ΠΈ 8,46 ΠΌ/Ρ [7,28; 9,96]Β ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ (p=0,007). ΠΡΠΈ ΡΡΠΎΠΌ ΡΠΎΠ»ΡΠΊΠΎ Ρ 6 (10%) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΈΡΡ
ΠΎΠ΄Π½ΠΎ ΠΈ Ρ 12 (20%) ΡΠ΅ΡΠ΅Π· 3 ΠΌΠ΅Ρ PWVAo Π±ΡΠ»Π° >10 ΠΌ/Ρ. Π Π³ΡΡΠΏΠΏΠ΅ Π±ΠΎΠ»ΡΠ½ΡΡ
, Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎ ΠΏΡΠΈΠ½ΠΈΠΌΠ°Π²ΡΠΈΡ
ΠΠΠΠ, AixAo ΠΈΡΡ
ΠΎΠ΄Π½ΠΎ ΡΠΎΡΡΠ°Π²Π»ΡΠ» 21,5% [11,08; 34,25], Π½Π° 12-ΠΉ Π½Π΅Π΄Π΅Π»Π΅ β 18,25% [09,33; 26,28]Β (p=0,3); PWVAo ΠΈΡΡ
ΠΎΠ΄Π½ΠΎ Π΄ΠΎΡΡΠΈΠ³Π°Π»Π° 7,6 ΠΌ/Ρ [6,56; 7,91], Π½Π° 12-ΠΉ Π½Π΅Π΄Π΅Π»Π΅ β7,8 ΠΌ/Ρ [7,22; 8,1] (p=0,12). ΠΡΠΈ ΡΡΠΎΠΌ ΠΈΡΡ
ΠΎΠ΄Π½ΠΎ PWVAoΒ >10 ΠΌ/Ρ Π²ΡΡΠ²Π»Π΅Π½Π° Ρ 20 (19,2%) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Π° ΡΠ΅ΡΠ΅Π· 60 ΠΌΠ΅Ρ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ ΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ β Ρ 22 (21,15%). ΠΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΎΠ΄Π½ΠΎΠ½Π°ΠΏΡΠ°Π²Π»Π΅Π½Π½ΡΠΌΠΈ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡΠΌΠΈ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΠΆΠ΅ΡΡΠΊΠΎΡΡΠΈ ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ ΡΡΠ΅Π½ΠΊΠΈ ΠΏΡΠΈ 3- ΠΈ 60-ΠΌΠ΅ΡΡΡΠ½ΠΎΠΌ ΠΏΡΠΈΠ΅ΠΌΠ΅ ΠΠΠΠ Π½Π΅ ΡΠ°Π·Π»ΠΈΡΠ°Π»ΠΎΡΡ.ΠΡΠ²ΠΎΠ΄Ρ. ΠΠ° ΡΠΎΠ½Π΅ 3-ΠΌΠ΅ΡΡΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΠΠΠ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΠ‘ ΠΎΡΠΌΠ΅ΡΠ΅Π½ΠΎ Π½Π΅Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠ΅ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ PWVAo ΠΏΡΠΈ ΠΎΡΡΡΡΡΡΠ²ΠΈΠΈ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ Π΄ΡΡΠ³ΠΈΡ
ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΠΆΠ΅ΡΡΠΊΠΎΡΡΠΈ ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ ΡΡΠ΅Π½ΠΊΠΈ. ΠΡΠΈ ΡΡΠΎΠΌ ΡΡΠ΅Π΄Π½Π΅Π΅ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ PWVAo ΠΎΡΡΠ°Π²Π°Π»ΠΎΡΡ Π² ΠΏΡΠ΅Π΄Π΅Π»Π°Ρ
Π½ΠΎΡΠΌΡ, Π° ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ Π΅Π΅ >10 ΠΌ/Ρ Π²ΡΡΠ²Π»Π΅Π½ΠΎ ΡΠΎΠ»ΡΠΊΠΎ Ρ 20% ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ². ΠΡΠΈ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΠ‘, Π½Π΅ ΠΈΠΌΠ΅ΡΡΠΈΡ
ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎ-ΡΠΎΡΡΠ΄ΠΈΡΡΡΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ, ΠΏΡΠΈΠ΅ΠΌ ΠΠΠΠ Π½Π΅ ΡΠΎΠΏΡΠΎΠ²ΠΎΠΆΠ΄Π°Π»ΡΡ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ΠΌ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΠΆΠ΅ΡΡΠΊΠΎΡΡΠΈ ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ ΡΡΠ΅Π½ΠΊΠΈ ΠΈ PWVAo
ΠΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ° ΡΠΏΠΎΠ½Π΄ΠΈΠ»ΠΎΠ°ΡΡΡΠΈΡΠ°: Π½ΡΠΆΠ½Ρ Π»ΠΈ Π½Π°ΠΌ Π½ΠΎΠ²ΡΠ΅ ΠΊΡΠΈΡΠ΅ΡΠΈΠΈ?
A large number of classification criteria for spondyloarthritis (SpA) are simultaneously used in modern rheumatology in the almost complete absence of diagnostic criteria. This poses a number of problems, among which there are two most important ones: 1) the frequent use of classification criteria to make a diagnosis in real clinical practice; 2) the possibility of stating different nosological entities of SpA in one patient in the presence of the same clinical picture.Objective: to investigate the specific features of the diagnosis of SpA and the use of its classification criteria in clinical practice.Subjects and methods. The investigation enrolled 119 patients with the established diagnosis of ankylosing spondylitis (AS), psoriatic arthritis (PsA), undifferentiated axial or peripheral SpA. Whether their clinical picture complied with the modified New York criteria, the European Spondyloarthropathy Study Group (ESSG) criteria, the Amor criteria, and the Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axial and peripheral SpA and whether the Russian version of the modified New York criteria complied with the Classification criteria of Psoriatic ARthritis (CASPAR) were determined in the patients.Results. Sixty-three patients diagnosed with AS (M45), 44 with PsA (M07.0-07.3), 8 with undifferentiated SpA (M46.9), and 4 with nonradiographic axial SpA (M46.8) were followed up by attending physicians. The latter diagnosed AS in 10 patients who met the ASAS criteria for axial PsA but not the modified New York criteria. Twenty-one patients diagnosed as having PsA simultaneously met both the CASPAR criteria and the modified New York criteria, which could establish the diagnosis of AS in these cases. Eighty-one (68.0%) out of the 119 patients met the Amor criteria; 98 (82.3%) patients, the ESSG criteria; 91 (76.5%), the ASAS criteria for axial SpA; 18 (15.1%), the ASAS criteria for peripheral SpA; 76 (63.8%), the modified New York criteria; 88 (73.9%), the Russian version of the modified New York criteria; 42 (32.3%), the CASPAR criteria. No intersection of criteria was observed in only 5 patients; 113 (94.9%) patients met β₯2 criteria; 96 (80.7%), β₯3 criteria; 81 (68.1%), β₯4 criteria; 66 (55.5%), simultaneously β₯5 criteria; and 18 (15.1%), simultaneously 6 criteria.Conclusion. Most patients with SpA meet β₯2 classification criteria, which gives the chance to state β₯2 nosological entities in the same patient. This demonstrates the elaboration of diagnostic criteria that can make a clear distinction between different forms of SpA in clinical practice.Β Π ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΠΉ ΡΠ΅Π²ΠΌΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ ΠΎΠ΄Π½ΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎ ΠΏΡΠΈΠΌΠ΅Π½ΡΠ΅ΡΡΡ Π±ΠΎΠ»ΡΡΠΎΠ΅ ΡΠΈΡΠ»ΠΎ ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΊΡΠΈΡΠ΅ΡΠΈΠ΅Π² ΡΠΏΠΎΠ½Π΄ΠΈΠ»ΠΎΠ°ΡΡΡΠΈΡΠ° (Π‘ΠΏΠ) ΠΏΡΠΈ ΠΏΠΎΡΡΠΈ ΠΏΠΎΠ»Π½ΠΎΠΌ ΠΎΡΡΡΡΡΡΠ²ΠΈΠΈ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΊΡΠΈΡΠ΅ΡΠΈΠ΅Π². ΠΡΠΎ ΡΠΎΠ·Π΄Π°Π΅Ρ ΡΡΠ΄ ΠΏΡΠΎΠ±Π»Π΅ΠΌ, ΠΈΠ· ΠΊΠΎΡΠΎΡΡΡ
Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ Π²Π°ΠΆΠ½ΡΠΌΠΈ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΡΡΡΡ Π΄Π²Π΅: ΡΠ°ΡΡΠΎΠ΅ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ Π² ΡΠ΅Π°Π»ΡΠ½ΠΎΠΉ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠ΅ ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΊΡΠΈΡΠ΅ΡΠΈΠ΅Π² Π΄Π»Ρ ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ Π΄ΠΈΠ°Π³Π½ΠΎΠ·Π°; Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ ΠΊΠΎΠ½ΡΡΠ°ΡΠ°ΡΠΈΠΈ ΡΠ°Π·Π½ΡΡ
Π½ΠΎΠ·ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠΎΡΠΌ Π‘ΠΏΠ Ρ ΠΎΠ΄Π½ΠΎΠ³ΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° ΠΏΡΠΈ ΠΎΠ΄Π½ΠΎΠΉ ΠΈ ΡΠΎΠΉ ΠΆΠ΅ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΊΠ°ΡΡΠΈΠ½Π΅.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΈΠ·ΡΡΠ΅Π½ΠΈΠ΅ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠ΅ΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ Π‘ΠΏΠ ΠΈ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΊΡΠΈΡΠ΅ΡΠΈΠ΅Π² Π² ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠ΅.ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠ΅Π½ΠΎ 119 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½Π½ΡΠΌ Π΄ΠΈΠ°Π³Π½ΠΎΠ·ΠΎΠΌ Π°Π½ΠΊΠΈΠ»ΠΎΠ·ΠΈΡΡΡΡΠ΅Π³ΠΎ ΡΠΏΠΎΠ½Π΄ΠΈΠ»ΠΈΡΠ° (ΠΠ‘), ΠΏΡΠΎΡΠΈΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π°ΡΡΡΠΈΡΠ° (ΠΡΠ), Π½Π΅Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ Π°ΠΊΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΈΠ»ΠΈ ΠΏΠ΅ΡΠΈΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠΏΠΎΠ½Π΄ΠΈΠ»ΠΎΠ°ΡΡΡΠΈΡΠ° (Π‘ΠΏΠ). Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ»ΠΈ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΠΈΠ΅ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΊΠ°ΡΡΠΈΠ½Ρ ΠΌΠΎΠ΄ΠΈΡΠΈΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΌ ΠΡΡ-ΠΠΎΡΠΊΡΠΊΠΈΠΌ ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ, ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ ΠΠ²ΡΠΎΠΏΠ΅ΠΉΡΠΊΠΎΠΉ Π³ΡΡΠΏΠΏΡ ΠΏΠΎ ΠΈΠ·ΡΡΠ΅Π½ΠΈΡ Π‘ΠΏΠ (European Spondyloarthropathy Study Group β ESSG), ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ Amor, ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ ASAS (Assessment of Spondyloarthritis International Society) Π΄Π»Ρ Π°ΠΊΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΈ ΠΏΠ΅ΡΠΈΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π‘ΠΏΠ, ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΠΈΠ΅ Π ΠΎΡΡΠΈΠΉΡΠΊΠΎΠΉ Π²Π΅ΡΡΠΈΠΈ ΠΌΠΎΠ΄ΠΈΡΠΈΡΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
ΠΡΡ-ΠΠΎΡΠΊΡΠΊΠΈΡ
ΠΊΡΠΈΡΠ΅ΡΠΈΠ΅Π² ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ CASPAR (Classification criteria for Psoriatic Arthritis) Π΄Π»Ρ ΠΡΠ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. 63 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Π½Π°Π±Π»ΡΠ΄Π°Π»ΠΈΡΡ Π»Π΅ΡΠ°ΡΠΈΠΌΠΈ Π²ΡΠ°ΡΠ°ΠΌΠΈ Ρ Π΄ΠΈΠ°Π³Π½ΠΎΠ·ΠΎΠΌ ΠΠ‘ (Π45), 44 β ΠΡΠ (Π07.0β07.3), 8 β Π½Π΅Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ Π‘ΠΏΠ (M46.9), 4 β Π°ΠΊΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π½Π΅ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π‘ΠΏΠ (M46.8). ΠΠ‘ Π±ΡΠ» Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠΎΠ²Π°Π½ Π»Π΅ΡΠ°ΡΠΈΠΌΠΈ Π²ΡΠ°ΡΠ°ΠΌΠΈ Ρ 10 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Π½Π΅ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΡΡΡΠΈΡ
ΠΌΠΎΠ΄ΠΈΡΠΈΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΌ ΠΡΡ-ΠΠΎΡΠΊΡΠΊΠΈΠΌ ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ, Π½ΠΎ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄ΡΡΠΈΡ
ΠΏΠΎΠ΄ ΠΊΡΠΈΡΠ΅ΡΠΈΠΈ ASAS Π΄Π»Ρ Π°ΠΊΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π‘ΠΏΠ. 21 ΠΏΠ°ΡΠΈΠ΅Π½Ρ Ρ Π΄ΠΈΠ°Π³Π½ΠΎΠ·ΠΎΠΌ ΠΡΠ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΠΎΠ²Π°Π» ΠΎΠ΄Π½ΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎ ΠΈ ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ CASPAR, ΠΈ ΠΌΠΎΠ΄ΠΈΡΠΈΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΌ ΠΡΡ-ΠΠΎΡΠΊΡΠΊΠΈΠΌ ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ, ΡΡΠΎ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ»ΠΎ ΡΡΡΠ°Π½ΠΎΠ²ΠΈΡΡ Π² ΡΡΠΈΡ
ΡΠ»ΡΡΠ°ΡΡ
Π΄ΠΈΠ°Π³Π½ΠΎΠ· ΠΠ‘. ΠΡΠΈΡΠ΅ΡΠΈΡΠΌ Amor ΡΠ΄ΠΎΠ²Π»Π΅ΡΠ²ΠΎΡΡΠ» 81 (68,0%) ΠΈΠ· 119 Π±ΠΎΠ»ΡΠ½ΡΡ
, ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ ESSG β 98 (82,3%) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ ASAS Π΄Π»Ρ Π°ΠΊΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π‘ΠΏΠ β 91 (76,5%), ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ ASAS Π΄Π»Ρ ΠΏΠ΅ΡΠΈΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π‘ΠΏΠ β 18 (15,1%), ΠΌΠΎΠ΄ΠΈΡΠΈΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΌ ΠΡΡ-ΠΠΎΡΠΊΡΠΊΠΈΠΌ ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ β 76 (63,8%), Π ΠΎΡΡΠΈΠΉΡΠΊΠΎΠΉ Π²Π΅ΡΡΠΈΠΈ ΠΌΠΎΠ΄ΠΈΡΠΈΡΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
ΠΡΡ-ΠΠΎΡΠΊΡΠΊΠΈΡ
ΠΊΡΠΈΡΠ΅ΡΠΈΠ΅Π² β 88 (73,9%), ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ CASPAR β 42 (32,3%). Β«ΠΠ΅ΡΠ΅ΡΠ΅ΡΠ΅Π½ΠΈΡΒ» ΠΊΡΠΈΡΠ΅ΡΠΈΠ΅Π² Π½Π΅ Π½Π°Π±Π»ΡΠ΄Π°Π»ΠΎΡΡ ΡΠΎΠ»ΡΠΊΠΎ Ρ 5 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², β₯2 ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΠΎΠ²Π°Π»ΠΈ 113 (94,9%) Π±ΠΎΠ»ΡΠ½ΡΡ
, β₯3 ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ β 96 (80,7%), β₯4 ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ β 81 (68,1%), β₯5 ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ β 66 (55,5%), 6 ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ β 18 (15,1%).ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²ΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠΎ Π‘ΠΏΠ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΡΡΡ β₯2 ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΎΠ½Π½ΡΠΌ ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ, ΡΡΠΎ ΡΠ°ΡΡΠΎ Π΄Π°Π΅Ρ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ Ρ ΠΎΠ΄Π½ΠΎΠ³ΠΎ ΠΈ ΡΠΎΠ³ΠΎ ΠΆΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° ΠΊΠΎΠ½ΡΡΠ°ΡΠΈΡΠΎΠ²Π°ΡΡ Π½Π°Π»ΠΈΡΠΈΠ΅ β₯2 Π½ΠΎΠ·ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠΎΡΠΌ. ΠΡΠΎ ΡΠΊΠ°Π·ΡΠ²Π°Π΅Ρ Π½Π° Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎΡΡΡ ΡΠ°Π·ΡΠ°Π±ΠΎΡΠΊΠΈ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΊΡΠΈΡΠ΅ΡΠΈΠ΅Π², ΠΏΠΎΠ·Π²ΠΎΠ»ΡΡΡΠΈΡ
ΡΠ΅ΡΠΊΠΎ ΡΠ°Π·Π³ΡΠ°Π½ΠΈΡΠΈΡΡ ΡΠ°Π·Π»ΠΈΡΠ½ΡΠ΅ ΡΠΎΡΠΌΡ Π‘ΠΏΠ Π² ΡΡΠ»ΠΎΠ²ΠΈΡΡ
ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠΈ.
ΠΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ Π°Π½ΠΊΠΈΠ»ΠΎΠ·ΠΈΡΡΡΡΠ΅Π³ΠΎ ΡΠΏΠΎΠ½Π΄ΠΈΠ»ΠΈΡΠ° ΠΏΡΠΈ Π½Π°Π»ΠΈΡΠΈΠΈ ΡΠ²Π΅ΠΈΡΠ° Ρ Π»ΠΈΡ ΡΠ°Π·Π½ΠΎΠ³ΠΎΠΏΠΎΠ»Π°
In patients with ankylosing spondylitis (AS), uveitis is its most common extraarticular manifestation (it occurs in 20β40% of cases).Objective: to study the specific features of diagnosis of AS in the presence of uveitis in persons of different sex.Subjects and methods. The study included 94 patients with AS. The rate of uveitis, patient age at its first episode, in the clinical manifestations of AS (inflammatory dorsalgia, arthritis, and enthesis), and in making a diagnosis, as well as disease activity were estimated in patients of different sex in the presence and absence of uveitis.Results. Uveitis as an extraskeletal manifestation of AS was stablished to more common in women (40%) than in men (15.8%). In female patients, the presence of uveitis is associated with early-onset AS as compared to those without uveitis. At the same time the diagnosis of AS was made in the women with uveitis 7 years later than in those without this condition. In one fifth of the patients, uveitis occurred before or concurrently with the appearance of the symptoms of locomotive lesion.Conclusion. Uveitis is more common in women with AS than in men and associated with the late detection of locomotive pathology.Π£ Π±ΠΎΠ»ΡΠ½ΡΡ
Π°Π½ΠΊΠΈΠ»ΠΎΠ·ΠΈΡΡΡΡΠΈΠΌ ΡΠΏΠΎΠ½Π΄ΠΈΠ»ΠΈΡΠΎΠΌ (ΠΠ‘) ΡΠ²Π΅ΠΈΡ ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΠ°ΠΌΡΠΌ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΡΠΌ Π²Π½Π΅ΡΡΡΡΠ°Π²Π½ΡΠΌΒ ΠΏΡΠΎΡΠ²Π»Π΅Π½ΠΈΠ΅ΠΌ Π±ΠΎΠ»Π΅Π·Π½ΠΈ (Π²ΡΡΡΠ΅ΡΠ°Π΅ΡΡΡ Π² 20β40% ΡΠ»ΡΡΠ°Π΅Π²).Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΈΠ·ΡΡΠ΅Π½ΠΈΠ΅ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠ΅ΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΠΠ‘ ΠΏΡΠΈ Π½Π°Π»ΠΈΡΠΈΠΈ ΡΠ²Π΅ΠΈΡΠ° Ρ Π»ΠΈΡ ΡΠ°Π·Π½ΠΎΠ³ΠΎ ΠΏΠΎΠ»Π°.ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠ΅Π½ΠΎ 94 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Ρ ΠΠ‘. ΠΡΠ΅Π½ΠΈΠ²Π°Π»ΠΈ ΡΠ°ΡΡΠΎΡΡ ΡΠ²Π΅ΠΈΡΠ°, Π²ΠΎΠ·ΡΠ°ΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π½Π° ΠΌΠΎΠΌΠ΅Π½Ρ ΠΏΠ΅Ρ-Π²ΠΎΠ³ΠΎ ΡΠΏΠΈΠ·ΠΎΠ΄Π° ΡΠ²Π΅ΠΈΡΠ°, ΠΏΡΠΈ ΠΌΠ°Π½ΠΈΡΠ΅ΡΡΠ°ΡΠΈΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΡΠΎΡΠ²Π»Π΅Π½ΠΈΠΉ ΠΠ‘ (Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½Π°Ρ Π±ΠΎΠ»Ρ Π² ΡΠΏΠΈΠ½Π΅, Π°ΡΡΡΠΈΡ, ΡΠ½ΡΠ΅Π·ΠΈΡ) ΠΈ ΠΏΡΠΈ ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΠΈ Π΄ΠΈΠ°Π³Π½ΠΎΠ·Π°, Π° ΡΠ°ΠΊΠΆΠ΅ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠ°Π·Π½ΠΎΠ³ΠΎ ΠΏΠΎΠ»Π° ΠΏΡΠΈ Π½Π°Π»ΠΈΡΠΈΠΈ ΠΈ ΠΎΡΡΡΡΡΡΠ²ΠΈΠΈ ΡΠ²Π΅ΠΈΡΠ°.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ. Π£ΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΎ, ΡΡΠΎ ΡΠ²Π΅ΠΈΡ ΠΊΠ°ΠΊ Π²Π½Π΅ΡΠΊΠ΅Π»Π΅ΡΠ½ΠΎΠ΅ ΠΏΡΠΎΡΠ²Π»Π΅Π½ΠΈΠ΅ ΠΠ‘ Ρ ΠΆΠ΅Π½ΡΠΈΠ½ Π²ΡΡΡΠ΅ΡΠ°Π΅ΡΡΡ ΡΠ°ΡΠ΅ (40%), ΡΠ΅ΠΌ Ρ ΠΌΡΠΆΡΠΈΠ½ (15,8%). Π£ ΠΆΠ΅Π½ΡΠΈΠ½ Π½Π°Π»ΠΈΡΠΈΠ΅ ΡΠ²Π΅ΠΈΡΠ° Π°ΡΡΠΎΡΠΈΠΈΡΡΠ΅ΡΡΡ Ρ ΡΠ°Π½Π½ΠΈΠΌ Π΄Π΅Π±ΡΡΠΎΠΌ ΠΠ‘ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠ°ΠΌΠΈ Π±Π΅Π· ΡΠ²Π΅ΠΈΡΠ°. ΠΡΠΈ ΡΡΠΎΠΌ Ρ ΠΆΠ΅Π½ΡΠΈΠ½ Ρ ΡΠ²Π΅ΠΈΡΠΎΠΌ Π΄ΠΈΠ°Π³Π½ΠΎΠ· ΠΠ‘ ΡΡΡΠ°Π½Π°Π²Π»ΠΈΠ²Π°Π»ΠΈ Π½Π° 7 Π»Π΅Ρ ΠΏΠΎΠ·ΠΆΠ΅, ΡΠ΅ΠΌ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠΊ Π±Π΅Π· ΡΠ²Π΅ΠΈΡΠ°. Π£ ΠΏΡΡΠΎΠΉ ΡΠ°ΡΡΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠΊ ΡΠ²Π΅ΠΈΡ Π΄Π΅Π±ΡΡΠΈΡΡΠ΅Ρ Π΄ΠΎ ΠΏΠΎΡΠ²Π»Π΅Π½ΠΈΡ ΡΠΈΠΌΠΏΡΠΎΠΌΠΎΠ² ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΡ ΠΎΠΏΠΎΡΠ½ΠΎ-Π΄Π²ΠΈΠ³Π°ΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ Π°ΠΏΠΏΠ°ΡΠ°ΡΠ° ΠΈΠ»ΠΈ ΠΎΠ΄Π½ΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎ Ρ Π½ΠΈΠΌΠΈ.ΠΡΠ²ΠΎΠ΄Ρ. Π£Π²Π΅ΠΈΡ Π²ΡΡΡΠ΅ΡΠ°Π΅ΡΡΡ Ρ ΠΆΠ΅Π½ΡΠΈΠ½ Ρ ΠΠ‘ ΡΠ°ΡΠ΅, ΡΠ΅ΠΌ Ρ ΠΌΡΠΆΡΠΈΠ½, ΠΈ Π°ΡΡΠΎΡΠΈΠΈΡΡΠ΅ΡΡΡ Ρ ΠΏΠΎΠ·Π΄Π½ΠΈΠΌ Π²ΡΡΠ²Π»Π΅Π½ΠΈΠ΅ΠΌ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ ΠΎΠΏΠΎΡΠ½ΠΎ-Π΄Π²ΠΈΠ³Π°ΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ Π°ΠΏΠΏΠ°ΡΠ°ΡΠ°
ΠΠΠΠΠΠΠΠΠ Π€Π£ΠΠΠ¦ΠΠ ΠΠΠ§ΠΠΠ Π£ ΠΠΠΠ¬ΠΠ«Π₯ Π‘ΠΠΠΠΠΠΠΠΠ Π’Π ΠΠ’ΠΠΠ, ΠΠΠΠ’ΠΠΠ¬ΠΠ ΠΠ ΠΠΠΠΠΠΠ¨ΠΠ₯ ΠΠΠ‘Π’ΠΠ ΠΠΠΠΠ«Π ΠΠ ΠΠ’ΠΠΠΠΠΠ‘ΠΠΠΠΠ’ΠΠΠ¬ΠΠ«Π ΠΠ ΠΠΠΠ ΠΠ’Π«: Π ΠΠΠ£ΠΠ¬Π’ΠΠ’Π« 10-ΠΠΠ’ΠΠΠΠ ΠΠ ΠΠ‘ΠΠΠΠ’ΠΠΠΠΠΠ ΠΠ‘Π‘ΠΠΠΠΠΠΠΠΠ― ΠΠ ΠΠΠ ΠΠ‘Π‘
Objective: to assess liver function changes in patients with spondyloarthritis (SpA) taking NSAIDs regularly over a long period.Patients and methods. The data obtained during a 10-year PROGRESS prospective single-center cohort study of functional status, activity, and comorbidity (including gastrointestinal tract diseases) in patients with SpA were analyzed. The data of 363 SpA patients receiving NSAIDs regularly over a long period and followed up for 10 years were also explored. The changes that had occurred over a decade in the liver enzyme levels, the number of discontinued NSAID treatments because of a persistent increase in liver enzyme levels, and the number of prescriptions of hepatoprotective agents were analyzed.Results. For 10 years, 18 patients with SpA discontinued their NSAID intake due to elevated liver enzyme levels (β₯3 times greater than the reference value); during that time, the same increase in enzyme levels was observed in 2 healthy individuals (Ο2 =1.39; p=0.2). In the patients with SpA as compared to the healthy individuals, the relative risk of abnormal liver function was 1.19 (95% CI, 1.009β1.405); odds ratio was 2.9 (95% CI, 0.65β12.95). There was no increased risk for discontinuation of some NSAIDs, including nimesulide (Ο2 =0.03, p=0.85), the frequency of using hepatoprotective drugs was proved to be highest for diclofenac sodium, ibuprofen, nimesulide, and ketoprofen.Conclusion. The regular long-term (as long as 10 years) use of NSAIDs to treat SpA is associated with treatment discontinuation because of elevated enzyme levels in every 10 patients. The maximum rate of discontinuation of NSAIDs due to a persistent increase in liver enzyme levels is observed 6β8 years after their regular use, so long-term NSAID therapy requires continuous monitoring of hepatic safety. The longterm intake of nimesulide, as compared with other NSAIDs, is shown to be unassociated with the higher rate of its discontinuation because of worse liver function. Hepatoprotectors are less frequently prescribed to patients taking nimesulide than to those receiving diclofenac sodium or ibuprofen and more frequently to patients using meloxicam. In most cases, prescribing hepatoprotective agents to patients receiving NSAIDs does not require discontinuation of anti-inflammatory therapy.Β ΠΠ»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠ΅ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ Π½Π΅ΡΡΠ΅ΡΠΎΠΈΠ΄Π½ΡΡ
ΠΏΡΠΎΡΠΈΠ²ΠΎΠ²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΡΡ
ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ² (ΠΠΠΠ) ΡΡΠ΅Π±ΡΠ΅Ρ ΠΏΠΎΠ²ΡΡΠ΅Π½Π½ΠΎΠ³ΠΎ Π²Π½ΠΈΠΌΠ°Π½ΠΈΡ ΠΊ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎΡΡΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ, Π² ΡΠΎΠΌ ΡΠΈΡΠ»Π΅ Π² ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠΈ ΡΡΠ½ΠΊΡΠΈΠΈ ΠΏΠ΅ΡΠ΅Π½ΠΈ.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΎΡΠ΅Π½ΠΊΠ° ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ ΡΡΠ½ΠΊΡΠΈΠΈ ΠΏΠ΅ΡΠ΅Π½ΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
ΡΠΏΠΎΠ½Π΄ΠΈΠ»ΠΎΠ°ΡΡΡΠΈΡΠ°ΠΌΠΈ (Π‘ΠΏΠ), ΡΠ΅Π³ΡΠ»ΡΡΠ½ΠΎ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎ ΠΏΡΠΈΠΌΠ΅Π½ΡΠ²ΡΠΈΡ
ΠΠΠΠ.ΠΠ°ΡΠΈΠ΅Π½ΡΡ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΡΠΎΠ²Π΅Π΄Π΅Π½ Π°Π½Π°Π»ΠΈΠ· Π΄Π°Π½Π½ΡΡ
, ΠΏΠΎΠ»ΡΡΠ΅Π½Π½ΡΡ
Π² Ρ
ΠΎΠ΄Π΅ 10-Π»Π΅ΡΠ½Π΅Π³ΠΎ ΠΏΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ³ΠΎ ΠΊΠΎΠ³ΠΎΡΡΠ½ΠΎΠ³ΠΎ ΠΎΠ΄Π½ΠΎΡΠ΅Π½ΡΡΠΎΠ²ΠΎΠ³ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ, ΠΏΠΎΡΠ²ΡΡΠ΅Π½Π½ΠΎΠ³ΠΎ ΠΈΠ·ΡΡΠ΅Π½ΠΈΡ ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ°ΡΡΡΠ°, Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΈ ΡΠΎΠΏΡΡΡΡΠ²ΡΡΡΠ΅ΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ (Π²ΠΊΠ»ΡΡΠ°Ρ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠ½ΠΎ-ΠΊΠΈΡΠ΅ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ°ΠΊΡΠ°) Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠΎ Π‘ΠΏΠ (ΠΠ ΠΠΠ ΠΠ‘Π‘). ΠΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Ρ Π΄Π°Π½Π½ΡΠ΅ 363 Π±ΠΎΠ»ΡΠ½ΡΡ
Π‘ΠΏΠ, Π½Π°Π±Π»ΡΠ΄Π°Π²ΡΠΈΡ
ΡΡ Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ 10 Π»Π΅Ρ, ΡΠ΅Π³ΡΠ»ΡΡΠ½ΠΎ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎ ΠΏΡΠΈΠ½ΠΈΠΌΠ°Π²ΡΠΈΡ
ΠΠΠΠ. ΠΠ½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π»ΠΈ ΠΏΡΠΎΠΈΠ·ΠΎΡΠ΅Π΄ΡΠΈΠ΅ Π·Π° 10 Π»Π΅Ρ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ ΡΡΠΎΠ²Π½Ρ ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠ½ΡΡ
ΡΠ΅ΡΠΌΠ΅Π½ΡΠΎΠ², ΡΠΈΡΠ»ΠΎ ΠΎΡΠΌΠ΅Π½ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΠΠΠ ΠΏΠΎ ΠΏΡΠΈΡΠΈΠ½Π΅ ΡΡΠΎΠΉΠΊΠΎΠ³ΠΎ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΡ ΡΡΠΎΠ²Π½Ρ ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠ½ΡΡ
ΡΠ΅ΡΠΌΠ΅Π½ΡΠΎΠ² ΠΈ ΡΠΈΡΠ»ΠΎ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΠΉ Π³Π΅ΠΏΠ°ΡΠΎΠΏΡΠΎΡΠ΅ΠΊΡΠΎΡΠΎΠ².Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠ° 10 Π»Π΅Ρ Ρ 18 Π±ΠΎΠ»ΡΠ½ΡΡ
Π‘ΠΏΠ ΠΈΠ·-Π·Π° ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΡ ΡΡΠΎΠ²Π½Ρ ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠ½ΡΡ
ΡΠ΅ΡΠΌΠ΅Π½ΡΠΎΠ² (β₯3 Π½ΠΎΡΠΌ) Π±ΡΠ» ΠΏΡΠ΅ΡΠ²Π°Π½ ΠΏΡΠΈΠ΅ΠΌ ΠΠΠΠ, Π·Π° ΡΡΠΎ Π²ΡΠ΅ΠΌΡ ΡΠ°ΠΊΠΎΠ΅ ΠΆΠ΅ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ ΡΡΠΎΠ²Π½Ρ ΡΠ΅ΡΠΌΠ΅Π½ΡΠΎΠ² ΠΎΡΠΌΠ΅ΡΠ΅Π½ΠΎ Ρ 2 Π·Π΄ΠΎΡΠΎΠ²ΡΡ
Π»ΠΈΡ (Ο2 =1,39, p=0,2). ΠΡΠ½ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΡΠΉ ΡΠΈΡΠΊ Π½Π°ΡΡΡΠ΅Π½ΠΈΡ ΡΡΠ½ΠΊΡΠΈΠΈ ΠΏΠ΅ΡΠ΅Π½ΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠΎ Π‘ΠΏΠ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ ΡΠΎ Π·Π΄ΠΎΡΠΎΠ²ΡΠΌΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ» 1,19 (95% ΠΠ 1,009β1,405), ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ ΡΠ°Π½ΡΠΎΠ² β 2,9 (95% ΠΠ 0,65β12,95). ΠΠ΅ ΠΎΡΠΌΠ΅ΡΠ΅Π½ΠΎ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΡ ΡΠΈΡΠΊΠ° ΠΎΡΠΌΠ΅Π½Ρ ΠΠΠΠ Π΄Π»Ρ ΠΎΡΠ΄Π΅Π»ΡΠ½ΡΡ
ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ², Π²ΠΊΠ»ΡΡΠ°Ρ Π½ΠΈΠΌΠ΅ΡΡΠ»ΠΈΠ΄Ρ (Ο2 =0,03, p=0,85), ΡΠ°ΡΡΠΎΡΠ° Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΡ Π³Π΅ΠΏΠ°ΡΠΎΠΏΡΠΎΡΠ΅ΠΊΡΠΎΡΠΎΠ² ΠΎΠΊΠ°Π·Π°Π»Π°ΡΡ ΠΌΠ°ΠΊΡΠΈΠΌΠ°Π»ΡΠ½ΠΎΠΉ Π΄Π»Ρ Π΄ΠΈΠΊΠ»ΠΎΡΠ΅Π½Π°ΠΊΠ° Π½Π°ΡΡΠΈΡ, ΠΈΠ±ΡΠΏΡΠΎΡΠ΅Π½Π°, Π½ΠΈΠΌΠ΅ΡΡΠ»ΠΈΠ΄Π° ΠΈ ΠΊΠ΅ΡΠΎΠΏΡΠΎΡΠ΅Π½Π°.ΠΡΠ²ΠΎΠ΄Ρ. Π Π΅Π³ΡΠ»ΡΡΠ½ΡΠΉ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΡΠΉ (Π΄ΠΎ 10 Π»Π΅Ρ) ΠΏΡΠΈΠ΅ΠΌ ΠΠΠΠ ΠΏΡΠΈ Π‘ΠΏΠ Π°ΡΡΠΎΡΠΈΠΈΡΡΠ΅ΡΡΡ Ρ ΠΎΡΠΌΠ΅Π½ΠΎΠΉ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΈΠ·-Π·Π° ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΡ ΡΡΠΎΠ²Π½Ρ ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠ½ΡΡ
ΡΠ΅ΡΠΌΠ΅Π½ΡΠΎΠ² Ρ 1 ΠΈΠ· 10 Π±ΠΎΠ»ΡΠ½ΡΡ
. ΠΠ°ΠΊΡΠΈΠΌΠ°Π»ΡΠ½Π°Ρ ΡΠ°ΡΡΠΎΡΠ° ΠΎΡΠΌΠ΅Π½ ΠΠΠΠ Π²ΡΠ»Π΅Π΄ΡΡΠ²ΠΈΠ΅ ΡΡΠΎΠΉΠΊΠΎΠ³ΠΎ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΡ ΡΡΠΎΠ²Π½Ρ ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠ½ΡΡ
ΡΠ΅ΡΠΌΠ΅Π½ΡΠΎΠ² ΠΎΡΠΌΠ΅ΡΠ°Π΅ΡΡΡ ΡΠ΅ΡΠ΅Π· 6β8 Π»Π΅Ρ ΠΈΡ
ΡΠ΅Π³ΡΠ»ΡΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠΈΠ΅ΠΌΠ°, ΠΏΠΎΡΡΠΎΠΌΡ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½Π°Ρ ΡΠ΅ΡΠ°ΠΏΠΈΡ ΠΠΠΠ ΡΡΠ΅Π±ΡΠ΅Ρ ΠΏΠΎΡΡΠΎΡΠ½Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ½ΠΈΡΠΎΡΠΈΠ½Π³Π° ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠ½ΠΎΠΉ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎΡΡΠΈ. ΠΡΠΈΠ΅ΠΌ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ² Π½ΠΈΠΌΠ΅ΡΡΠ»ΠΈΠ΄Π° Π² Π΄ΠΎΠ»Π³ΠΎΡΡΠΎΡΠ½ΠΎΠΉ ΠΏΠ΅ΡΡΠΏΠ΅ΠΊΡΠΈΠ²Π΅ Π½Π΅ Π°ΡΡΠΎΡΠΈΠΈΡΡΠ΅ΡΡΡ Ρ Π±ΠΎΠ»ΡΡΠ΅ΠΉ ΡΠ°ΡΡΠΎΡΠΎΠΉ ΠΈΡ
ΠΎΡΠΌΠ΅Π½ ΠΈΠ·-Π·Π° ΡΡ
ΡΠ΄ΡΠ΅Π½ΠΈΡ ΡΡΠ½ΠΊΡΠΈΠΈ ΠΏΠ΅ΡΠ΅Π½ΠΈ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ Π΄ΡΡΠ³ΠΈΠΌΠΈ ΠΠΠΠ. ΠΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ, ΠΏΡΠΈΠ½ΠΈΠΌΠ°ΡΡΠΈΠΌ Π½ΠΈΠΌΠ΅ΡΡΠ»ΠΈΠ΄, Π³Π΅ΠΏΠ°ΡΠΎΠΏΡΠΎΡΠ΅ΠΊΡΠΎΡΡ Π½Π°Π·Π½Π°ΡΠ°ΡΡΡΡ ΡΠ΅ΠΆΠ΅, ΡΠ΅ΠΌ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ, ΠΏΠΎΠ»ΡΡΠ°ΡΡΠΈΠΌ Π΄ΠΈΠΊΠ»ΠΎΡΠ΅Π½Π°ΠΊ Π½Π°ΡΡΠΈΡ ΠΈΠ»ΠΈ ΠΈΠ±ΡΠΏΡΠΎΡΠ΅Π½, ΠΈ ΡΠ°ΡΠ΅, ΡΠ΅ΠΌ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ, ΠΏΡΠΈΠ½ΠΈΠΌΠ°ΡΡΠΈΠΌ ΠΌΠ΅Π»ΠΎΠΊΡΠΈΠΊΠ°ΠΌ. Π Π±ΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²Π΅ ΡΠ»ΡΡΠ°Π΅Π² Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ Π³Π΅ΠΏΠ°ΡΠΎΠΏΡΠΎΡΠ΅ΠΊΡΠΎΡΠΎΠ² Π½Π° ΡΠΎΠ½Π΅ ΠΏΡΠΈΠ΅ΠΌΠ° ΠΠΠΠ Π½Π΅ ΡΡΠ΅Π±ΡΠ΅Ρ ΠΎΡΠΌΠ΅Π½Ρ ΠΏΡΠΎΡΠΈΠ²ΠΎΠ²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ.
Clinical features of post-COVID-19 period. Results of the international register βDynamic analysis of comorbidities in SARS-CoV-2 survivors (AKTIV SARS-CoV-2)β. Data from 6-month follow-up
Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 β 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period
Specific features of axial spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, in persons of different genders
The increasing number of women with ankylosing spondyloarthritis (SpA) makes it relevant to study the specific features of this disease in persons of different genders.Objective: to study the indicators of activity and functional status in male and female patients with axial SpA.Subjects and methods. The study enrolled 91 patients (43 women and 48 men) with axial SpA admitted to the Rheumatology Unit of the Saratov Regional Clinical Hospital in 2013. The age of the women and men was 41.63Β±12.04 and 41.94Β±12.76 years, respectively. All the patients fulfilled the ASAS criteria for axial SpA. 60.43% of the patients had ankylosing spondylitis (AS) meeting the modified New York criteria; 26.37% had psoriatic arthritis (PsA) according to the CASPAR criteria (only patients with axial involvement were included in the study and those with peripheral arthritis were excluded); 9.89% had undifferentiated axial SpA. Age at symptom onset, disease duration, and age at diagnosis of axial SpA were taken into account. The activity of axial SpA (ASDAS, BASDAI, highsensitivity C-reactive protein) and the mobility of the axial skeleton (BASMI and its components) were investigated in patients of different genders.Results. The study has established that the women are hospitalized with diagnosed axial SpA as often as the men. The indicators of activity and axial skeleton mobility are similar in the male and female patients with axial SpA as a whole and with a disease history of less than 10 years. Having a disease history of more than 10 years, the women preserve greater mobility of the lumbar and cervical spine than do the men with the similar disease activity