rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2009-1151rsp-1065Research ArticleСтатьиArticlesВоспалительная боль в нижней части спины в ранней диагностике спондилоартритовInflammatory low back pain in early diagnosis of spondyloarthritidesDubininaT VDubininaT V-ErdesShErdesSh-200915082009474№4 (2009)5563Copyright © Dubinina T.V., Erdes S., 20092009Dubinina T.V., Erdes S.Dubinina T.V., Erdes S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/1065

Боль в нижней части спины (БНС) – одна из наиболее частых жалоб пациентов в общемедицинской практике. Она встречается примерно с одинаковой частотой в различных этнических популяциях. Значительное снижение качества жизни и работоспособности лиц трудоспособного возраста, возрастающая стоимость лечения и обследования, компенсационные выплаты делают БНС одной из наиболее социально значимых проблем современного мира. Очевидно, что часть бремени БНС возникает из-за ненужного обследования пациентов в одних случаях и/или неэффективного использования его данных – в других, а также вследствие недостаточного понимания ее причин [1].

References<div><p>Deyo R.A., Weinstein J.N. Low back pain. N. Engl. J. Med., 2001,344,363–70</p><p>Refshauge K.M., Maher C.G. Low back pain investigations and prognosis: a review. Br. J. Sports Med., 2006,40,494-8</p><p>Эрдес Ш. Принципы диагностики и лечения болей в нижней части спины. Научно-практич. ревматол.,2006,2,37-44</p><p>Неспецифическая боль в нижней части спины. Клинические рекомендации для участковых терапевтов и врачей общей практики. М.,2008,71с.</p><p>Khan M.A.Update on Spondyloarthropathies. Ann. Intern. Med., 2002,136,896-907.</p><p>Rudwaleit M., van der Heijde D., Khan M.A.et al. How to diagnose axial spondyloarthritis early. Ann. Rheum.Dis.,2004,63,535-43.</p><p>Said-Nahal R., Miceli-Richard C., Berthelot J.M.et al, on behalf of the Groupe Francais d’ Etude Genetique des Spondylarthropathies. The familial form of spon- dylarthropathy: a clinical study of 115 multiplex fami- lies. Arthritis Rheum., 2000, 43, 1356-65.</p><p>Rudwaleit M., Khan M.A., Sieper J. The challenge of diagnosis and classification in early ankylosing spondylitis: do we need new criteria? Arthritis Rheum., 2005,52,1000-8.</p><p>Van Tubergen A., Heuft-Dorenbosch L., SchulpenG. Radiographic assessment of sacroiliitis by radiologist and rheumatologists: does training improve quality? Ann.Rheum. Dis., 2003,62,519–25</p><p>Jois R.N., Macgregor A.J., Gaffney K. Recognition of inflammatory back pain and ankylosing spondylitis in primary care. Rheumatology,2008,47(9),1364-6.</p><p>Koehler L., Kuipers J. G., Zeidler H. Managing seronegative spondarthritides. Rheumatology,2000, 39, 360-8</p><p>Nash P., Mease P., Braun J. et al. Seronegative spondyloarthropathies: to lump or split? Ann.Rheum. Dis., 2005, 64, 9-13</p><p>Sieper J., Braun J., Rudwaleit M.et al. Ankylosing spondylitis: an overview. Ann.Rheum. Dis., 2002,61, 8–18</p><p>Zochling J., van der Heijde D., Dougados M., Braun J. Current evidence for the management of ankylosing spondylitis: a systematic literature review for the ASAS/ EULAR management recommendations in ankylosing spondylitis. Ann.Rheum. Dis., 2006,65, 423-32</p><p>Lawrence H Brent. Ankylosing spondylitis and undif- ferentiated spondyloarthropathy. Medicine J., 2006, 7, 12</p><p>Годзенко А.А. Недифференцированные формы спондилоартритов: проблемы диагностики и классификации. Consilium Medicum, 2006,8, 2, 15-9</p><p>Wollenhaupt J, Zeidler H. Undifferentiated arthritis ahd reactive arthritis. Curr.Opin. Rheum., 1998,10, 306-13.</p><p>Braun J., Sieper J. Building consensus on nomencla- ture and disease classification for ankylosing spondylitis: results and discussion of a questionnaire prepared for the International Workshop on New Treatment Strategies in Ankylosing Spondylitis, Berlin, Germany, 18-19 January 2002. Ann.Rheum.Dis., 2002,61,61-7.</p><p>Braun J, Landewe R, Hermann KA, et al. Major reduction in spinal inflammation in patients with ankylosing spondylitis after treatment with infliximab. Results of a multicenter, randomized, double-blind, placebo-controlled magnetic resonance imaging study. Arthritis Rheum., 2006, 54,1646-52.</p><p>Davis JC Jr, van der Heijde D, Braun J, et al. Recombinant human tumor necrosis factor recep- tor (etanercept) for treating ankylosing spondylitis: a randomized controlled trial. Arthritis Rheum., 2003, 48,3230-6.</p><p>Van der Heijde D., Dijkmans B., Geusens P., et al. Efficacy and safety of infliximab in patients with anky- losing spondylitis. Results of a randomized, placebo- controlled trial (ASSERT). Arthritis Rheum.,2005, 52,582-91.</p><p>Van der Heijde D., Kivitz A., Schiff M.H., et al. Efficacy and safety of adalimumab in patients with ankylosing spondylitis. Results of a multicenter, ran- domized, double-blind, placebo-controlled trial. Arthritis Rheum.,2006, 54,2136-46.</p><p>Zochling J., van der Heijde D., Burgos-Vargas R., Collantes E., Davis J., Dijkmans B., et al. ASAS/ EULAR recommendations for the management of ankylosing spondylitis. Ann. Rheum.Dis., 2006,54, 442-52.</p><p>Barkham N., Marzo-Ortega H., McGonagleD, Emery P. How to diagnose axial spondyloarthropathy early. Ann.Rheum.Dis., 2004,63,471-2</p><p>McVeigh C.M., Cairns A.P.Diagnosis and management of ankylosing spondylitis. BMJ, 2006,333,581-5</p><p>Sieper J., Rudwaleit M. Early referral recommendations for ankylosing spondylitis (including pre-radiographic and radiographic forms) in primary care. Ann. Rheum. Dis., 2005,64,659-63.</p><p>Sieper J., Van der Heijde D.M., Landewé R.B.M. et al. New criteria for inflammatory back pain in patients with chronic back pain a real patient exercise of the Assessment in SpondyloArthritis international Society (ASAS). Ann.Rheum. Dis.,published online 15 Jan 2009.</p><p>Rudwaleit M, Metter A, Listing J, Sieper J, Braun J. Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history for application as classification and diagnostic criteria. Arthritis Rheum., 2006,54,569-78.</p><p>Эрдес Ш., Дубинина Т.В., Галушко Е.А. Частота и характер болей в нижней части спины среди амбулаторных больных в г. Москве.Сообщение II. Научно-практич. ревматол., 2008, 2,6-12</p><p>Braun J., Khan M.A., Sieper J. Enthesitis and anky- losis in spondyloarthropathy: what is the target of the immune response? Ann.Rheum.Dis., 2000,59,985-94.</p><p>McGonagle D., Stockwin L., Isaacs J., Emery P. An enthesitis based model for spondyloarthropathy. J. Rheumatol .,2001, 28,2155-9.</p><p>McGonagle D, Khan M, Marzo-Ortega H et al. Enthesitis in spondyloarthropathy. Curr. Opin. Rheumatol., 1999, 11,244-50.</p><p>Ball J. Entesopathy of rheumatoid and spondylitis. Ann Rheum Dis 1971; 30: 213-23.</p><p>Dougados M., van der Linden S., Juhlin R.., et al. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylar- thropathy. Arthritis Rheum., 1991,34,1218–27.</p><p>Rojas-Vargas M., Munoz-Gomariz E., Escudero А., et al. First signs and symptoms of spondyloarthritis — data from an inception cohort with a disease course of two years or less (REGISPONSER-Early). Rheumatology, 2009,48,404–9</p><p>Padula A., Giasi V., Olivieri I. Elderly onset iso- lated B27 associated dactylitis. Ann. Rheum.Dis., 2002,61,759-60.</p><p>Olivieri I., Padula A., Scarano E., Scarpa R. Dactylitis or “Sausage-Shaped” digit. J. Rheumatol., 2007,34, 1217–22</p><p>Olivieri I., D’Angelo E., Scarano E., Padula A.What is the primary lesion in SpA dactylitis? Rheumatology, 2008, 47(5),561-2</p><p>Olivieri I., Barozzi L., Favaro L., et al. Dactylitis in patients with seronegative spondylarthropathy: assessment by ultrasonography and magnetic resonance imaging. Arthritis Rheum., 1996,39,1524-8</p><p>Taylor W., Gladman D., Helliwell P., et al. Classification criteria for psoriatic arthritis: Development of new criteria from a large international study. Arthritis Rheum., 2006,54,2665-73</p><p>Pato E., Bañares A., Jover J.A., et al. Undiagnosed spondyloarthropathy in patients presenting with anterior uveitis. J.Rheumatol., 2000,27,2198-202.</p><p>Linder R., Hoffmann A., Brunner R. Prevalence of the spondyloarthritides in patients with uveitis. J. Rheumatol., 2004,31,2226-9</p><p>Feltkamp T., Ringrose J. Acute anterior uveitis and spondyloarthropathies. Curr. Opin. Rheum., 1998,10, 314-8</p><p>Bergfeldt L. HLA-B27-associated cardiac disease. Ann.Med.Interne., 1997,127,8,621-9</p><p>Moll J.M., Wright V. New York clinical criteria for ankylosing spondylitis: a statistical evaluation. Ann. Rheum.Dis., 1973,32,354-63</p><p>Агабабова Э.Р., Бунчук Н.В., Шубин С.В., и соавт. Критерии диагноза реактивных артритов (проект). Научно-практич. ревматол.,2003,3,82-3.</p><p>Коротаева Т. В. Псориатический артрит. Справочник поликл. врача, 2006, 4, 4, 51-6</p><p>Brandt HC, Spiller I, Song I, et al. Performance of referral recommendations in patients with chronic back pain and suspected axial spondyloarthritis. Ann. Rheum.Dis.,2007, 66,1479-84.</p><p>Sidiropoulos P.I., Hatemi G., Song I.-H et al. Evidence-based recommendations for the management of ankylosing spondylitis: systematic literature search of the 3E Initiative in Rheumatology involving a broad panel of experts and practicing rheumatologists. Rheumatology, 2008,47,355-61</p></div><br /><div><p>Deyo R.A., Weinstein J.N. Low back pain. N. Engl. J. Med., 2001,344,363–70</p><p>Refshauge K.M., Maher C.G. Low back pain investigations and prognosis: a review. Br. J. Sports Med., 2006,40,494-8</p><p>Эрдес Ш. Принципы диагностики и лечения болей в нижней части спины. Научно-практич. ревматол.,2006,2,37-44</p><p>Неспецифическая боль в нижней части спины. Клинические рекомендации для участковых терапевтов и врачей общей практики. М.,2008,71с.</p><p>Khan M.A.Update on Spondyloarthropathies. Ann. Intern. Med., 2002,136,896-907.</p><p>Rudwaleit M., van der Heijde D., Khan M.A.et al. How to diagnose axial spondyloarthritis early. Ann. Rheum.Dis.,2004,63,535-43.</p><p>Said-Nahal R., Miceli-Richard C., Berthelot J.M.et al, on behalf of the Groupe Francais d’ Etude Genetique des Spondylarthropathies. The familial form of spon- dylarthropathy: a clinical study of 115 multiplex fami- lies. Arthritis Rheum., 2000, 43, 1356-65.</p><p>Rudwaleit M., Khan M.A., Sieper J. The challenge of diagnosis and classification in early ankylosing spondylitis: do we need new criteria? Arthritis Rheum., 2005,52,1000-8.</p><p>Van Tubergen A., Heuft-Dorenbosch L., SchulpenG. Radiographic assessment of sacroiliitis by radiologist and rheumatologists: does training improve quality? Ann.Rheum. Dis., 2003,62,519–25</p><p>Jois R.N., Macgregor A.J., Gaffney K. Recognition of inflammatory back pain and ankylosing spondylitis in primary care. Rheumatology,2008,47(9),1364-6.</p><p>Koehler L., Kuipers J. G., Zeidler H. Managing seronegative spondarthritides. Rheumatology,2000, 39, 360-8</p><p>Nash P., Mease P., Braun J. et al. Seronegative spondyloarthropathies: to lump or split? Ann.Rheum. Dis., 2005, 64, 9-13</p><p>Sieper J., Braun J., Rudwaleit M.et al. Ankylosing spondylitis: an overview. Ann.Rheum. Dis., 2002,61, 8–18</p><p>Zochling J., van der Heijde D., Dougados M., Braun J. Current evidence for the management of ankylosing spondylitis: a systematic literature review for the ASAS/ EULAR management recommendations in ankylosing spondylitis. Ann.Rheum. Dis., 2006,65, 423-32</p><p>Lawrence H Brent. Ankylosing spondylitis and undif- ferentiated spondyloarthropathy. Medicine J., 2006, 7, 12</p><p>Годзенко А.А. Недифференцированные формы спондилоартритов: проблемы диагностики и классификации. Consilium Medicum, 2006,8, 2, 15-9</p><p>Wollenhaupt J, Zeidler H. Undifferentiated arthritis ahd reactive arthritis. Curr.Opin. Rheum., 1998,10, 306-13.</p><p>Braun J., Sieper J. Building consensus on nomencla- ture and disease classification for ankylosing spondylitis: results and discussion of a questionnaire prepared for the International Workshop on New Treatment Strategies in Ankylosing Spondylitis, Berlin, Germany, 18-19 January 2002. Ann.Rheum.Dis., 2002,61,61-7.</p><p>Braun J, Landewe R, Hermann KA, et al. Major reduction in spinal inflammation in patients with ankylosing spondylitis after treatment with infliximab. Results of a multicenter, randomized, double-blind, placebo-controlled magnetic resonance imaging study. Arthritis Rheum., 2006, 54,1646-52.</p><p>Davis JC Jr, van der Heijde D, Braun J, et al. Recombinant human tumor necrosis factor recep- tor (etanercept) for treating ankylosing spondylitis: a randomized controlled trial. Arthritis Rheum., 2003, 48,3230-6.</p><p>Van der Heijde D., Dijkmans B., Geusens P., et al. Efficacy and safety of infliximab in patients with anky- losing spondylitis. Results of a randomized, placebo- controlled trial (ASSERT). Arthritis Rheum.,2005, 52,582-91.</p><p>Van der Heijde D., Kivitz A., Schiff M.H., et al. Efficacy and safety of adalimumab in patients with ankylosing spondylitis. Results of a multicenter, ran- domized, double-blind, placebo-controlled trial. Arthritis Rheum.,2006, 54,2136-46.</p><p>Zochling J., van der Heijde D., Burgos-Vargas R., Collantes E., Davis J., Dijkmans B., et al. ASAS/ EULAR recommendations for the management of ankylosing spondylitis. Ann. Rheum.Dis., 2006,54, 442-52.</p><p>Barkham N., Marzo-Ortega H., McGonagleD, Emery P. How to diagnose axial spondyloarthropathy early. Ann.Rheum.Dis., 2004,63,471-2</p><p>McVeigh C.M., Cairns A.P.Diagnosis and management of ankylosing spondylitis. BMJ, 2006,333,581-5</p><p>Sieper J., Rudwaleit M. Early referral recommendations for ankylosing spondylitis (including pre-radiographic and radiographic forms) in primary care. Ann. Rheum. Dis., 2005,64,659-63.</p><p>Sieper J., Van der Heijde D.M., Landewé R.B.M. et al. New criteria for inflammatory back pain in patients with chronic back pain a real patient exercise of the Assessment in SpondyloArthritis international Society (ASAS). Ann.Rheum. Dis.,published online 15 Jan 2009.</p><p>Rudwaleit M, Metter A, Listing J, Sieper J, Braun J. Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history for application as classification and diagnostic criteria. Arthritis Rheum., 2006,54,569-78.</p><p>Эрдес Ш., Дубинина Т.В., Галушко Е.А. Частота и характер болей в нижней части спины среди амбулаторных больных в г. Москве.Сообщение II. Научно-практич. ревматол., 2008, 2,6-12</p><p>Braun J., Khan M.A., Sieper J. Enthesitis and anky- losis in spondyloarthropathy: what is the target of the immune response? Ann.Rheum.Dis., 2000,59,985-94.</p><p>McGonagle D., Stockwin L., Isaacs J., Emery P. An enthesitis based model for spondyloarthropathy. J. Rheumatol .,2001, 28,2155-9.</p><p>McGonagle D, Khan M, Marzo-Ortega H et al. Enthesitis in spondyloarthropathy. Curr. Opin. Rheumatol., 1999, 11,244-50.</p><p>Ball J. Entesopathy of rheumatoid and spondylitis. Ann Rheum Dis 1971; 30: 213-23.</p><p>Dougados M., van der Linden S., Juhlin R.., et al. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylar- thropathy. Arthritis Rheum., 1991,34,1218–27.</p><p>Rojas-Vargas M., Munoz-Gomariz E., Escudero А., et al. First signs and symptoms of spondyloarthritis — data from an inception cohort with a disease course of two years or less (REGISPONSER-Early). Rheumatology, 2009,48,404–9</p><p>Padula A., Giasi V., Olivieri I. Elderly onset iso- lated B27 associated dactylitis. Ann. Rheum.Dis., 2002,61,759-60.</p><p>Olivieri I., Padula A., Scarano E., Scarpa R. Dactylitis or “Sausage-Shaped” digit. J. Rheumatol., 2007,34, 1217–22</p><p>Olivieri I., D’Angelo E., Scarano E., Padula A.What is the primary lesion in SpA dactylitis? Rheumatology, 2008, 47(5),561-2</p><p>Olivieri I., Barozzi L., Favaro L., et al. Dactylitis in patients with seronegative spondylarthropathy: assessment by ultrasonography and magnetic resonance imaging. Arthritis Rheum., 1996,39,1524-8</p><p>Taylor W., Gladman D., Helliwell P., et al. Classification criteria for psoriatic arthritis: Development of new criteria from a large international study. Arthritis Rheum., 2006,54,2665-73</p><p>Pato E., Bañares A., Jover J.A., et al. Undiagnosed spondyloarthropathy in patients presenting with anterior uveitis. J.Rheumatol., 2000,27,2198-202.</p><p>Linder R., Hoffmann A., Brunner R. Prevalence of the spondyloarthritides in patients with uveitis. J. Rheumatol., 2004,31,2226-9</p><p>Feltkamp T., Ringrose J. Acute anterior uveitis and spondyloarthropathies. Curr. Opin. Rheum., 1998,10, 314-8</p><p>Bergfeldt L. HLA-B27-associated cardiac disease. Ann.Med.Interne., 1997,127,8,621-9</p><p>Moll J.M., Wright V. New York clinical criteria for ankylosing spondylitis: a statistical evaluation. Ann. Rheum.Dis., 1973,32,354-63</p><p>Агабабова Э.Р., Бунчук Н.В., Шубин С.В., и соавт. Критерии диагноза реактивных артритов (проект). Научно-практич. ревматол.,2003,3,82-3.</p><p>Коротаева Т. В. Псориатический артрит. Справочник поликл. врача, 2006, 4, 4, 51-6</p><p>Brandt HC, Spiller I, Song I, et al. Performance of referral recommendations in patients with chronic back pain and suspected axial spondyloarthritis. Ann. Rheum.Dis.,2007, 66,1479-84.</p><p>Sidiropoulos P.I., Hatemi G., Song I.-H et al. Evidence-based recommendations for the management of ankylosing spondylitis: systematic literature search of the 3E Initiative in Rheumatology involving a broad panel of experts and practicing rheumatologists. Rheumatology, 2008,47,355-61</p></div><br />

The authors declare that there are no conflicts of interest present.