rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2013-1195rsp-1105Research ArticleСтатьиArticlesЛечение больных анкилозирующим спондилитом в реальной практике врача-ревматолога в РоссииTREATMENT IN PATIENTS WITH ANKYLOSING SPONDYLITIS IN THE REAL CLINICAL PRACTICE OF A RHEUMATOLOGIST IN RUSSIAЭрдесШ. Ф.ErdesSh FВолнухинЕ. В.VolnuhinEvgeny Vladimirovichdrzhe07@rambler.ruГалушкоЕ. А.GalushkoE AФедеральное государственное бюджетное учреждение «Научно- исследовательский институт ревматологии» РАМН, Москва201315022013511№1 (2013)1520Copyright © Эрдес Ш.Ф., Волнухин Е.В., Галушко Е.А., 20132013Эрдес Ш.Ф., Волнухин Е.В., Галушко Е.А.Erdes S.F., Volnuhin E.V., Galushko E.A.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/1105

Цель проанализировать особенности лечения анкилозирующего спондилита (АС) в реальной практике врача-ревматолога в России. Материал и методы. В одномоментное исследование включено 330 больных АС, активно обратившихся к ревматологам в течение 4 мес в 24 городах Российской Федерации. Характер проводимой терапии изучался на основании анамнестических данных, внесенных врачами в специально разработанную клиническую карту. У всех больных выясняли фармакологический анамнез, регулярность приема лекарств, причины их отмены, а также клинический эффект. Потребность в усилении терапии и назначении генно-инженерных биологических препаратов определялась на основании активности заболевания на момент осмотра. Результаты. В анамнезе 62% больных получали нестероидные противовоспалительные препараты (НПВП) регулярно, 34% периодически, а 4% не лечились; 2/3 больных принимали диклофенак, нимесулид или мелоксикам. Сульфасалазин принимали 33% больных, метотрексат 14%, глюкокортикоиды перорально 9%. Ингибиторы фактора некроза опухоли α (ФНОа) получали 60 (18%) больных. Различные физиотерапевтические методы лечения применялись в 30% случаев, регулярно физическими упражнениями занимались только 46%, санаторно-курортное лечение прошли лишь 4% пациентов. По мнению врачей, в усилении терапии нуждался 81% больных, а в терапии ингибиторами ФНОа 62%. В то же время в соответствии с рекомендациями, разработанными ASAS, назначение ингибиторов ФНОа было показано 38% больным. Выводы. Лечение АС в реальной клинической практике не всегда соответствует современным рекомендациям: только 62% больных получали постоянно терапию НПВП, базисные противовоспалительные препараты часто использовались без показаний. Ингибиторы ФНОа получали 18% больных, адействительная потребность в их назначении имелась у 38%.

Objective: to analyze the treatment of ankylosing spondylitis (AS) in the real practice of a rheumatologist in Russia. Subjects and methods. The cross-sectional study included 330 AS patients who had been actively seeking medical advice from rheumatologists during 4 months in 24 cities and towns of the Russian Federation. The therapy performed was studied using the medical history data recorded by physicians in the specially designed clinical chart. Drug intake, its regularity, reasons for discontinuation of medications, and their clinical effect were elucidated in all the patients. The need to intensify the therapy and to use genetically engineered biological agents was determined by disease activity at the time of examination. Results. The medical histories indicated that 62% of the patients received nonsteroidal anti-inflammatory drugs (NSAIDs) regularly, 34% had them periodically, and 4% were not treated; two thirds of the patients took diclofenac, nimesulide, or meloxicam. 33, 14, and 9% of the patients used sulfasalazine, methotrexate, and oral glucocorticosteroids, respectively. Sixty (18%) patients received tumor necrosis factor-α (TNF-α) inhibitors. Different physiotherapeutic methods were used in 30% of cases; only 46% did exercises regularly; as high as 4% of the patients had sanatorium-and-spa treatment. In the physicians' opinion, 81% of the patients needed intensified therapy and 62% did therapy with TNF-α inhibitors. At the same time TNF-α inhibitors were indicated in 38% of the patients according to the ASAS recommendations. Conclusion. In real clinical practice, AS treatment does not always meet the current recommendations: only 62% of the patients received continuous NSAID therapy; disease-modifying antirheumatic drugs were frequently used without any indications. 18% of the patients took TNF-α inhibitors and 38% really needed them.

анкилозирующий спондилитнестероидные противовоспалительные препаратыингибиторы фактора некроза опухоли ареальная клиническая практикаankylosing spondylitisnonsteroidal anti-inflammatory drugstumor necrosis factor-α inhibitorsreal clinical practiceReferences<div><p>Braun J., van den Berg R., Baraliakos X. et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2011;70:896-904.</p><p>Analay Y., Ozcan E., Karan A. et al. The effectiveness of intensive group exercise on patients with ankylosing spondylitis. Clin Rehabil 2003;17:631-6.</p><p>Dagfinrud H., Kvien T.K., Hagen K.B. Physiotherapy interventions for ankylosing spondylitis. Cochrane Data base Syst Rev 2008(1); CD002822.</p><p>Mihai B., van der Linden S., de Bie R., Stucki G. Experts' beliefs on physiotherapy for patients with ankylosing spondylitis and assessment of their knowledge on published evidence in the field. Results of a questionnaire among international ASAS members. Eura Medicophys 2005;41:149-53.</p><p>Wanders A., Heijde D., Landewe R. et al. Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: a randomized clinical trial. Arthr Rheum 2005;52:1756-65.</p><p>Braun J., Zochling J., Baraliakos X. et al. Efficacy of sulfasalazine in patients with inflammatory back pain due to undifferentiated spondyloarthritis and early ankylosing spondylitis: a multicenter randomised controlled trial. Ann Rheum Dis 2006;65:1147-53.</p><p>Braun J., van der Horst-Bruinsma I.E., Huang F. et al. Clinical efficacy and safety of etanercept versus sulfasalazine in ankylosing spondylitis patients: a randomized, double-blind study (ASCEND Trial). Arthr Rheum 2011;63(3):1543.</p><p>Van der Heijde D., Sieper J., Maksymowych W.P. et al. (Second) Update of the ASAS recommendations on the use of TNF-blockers in ankylosing spondylitis. Arthr Rheum 2009;60(Suppl 10):1790.</p><p>Волнухин Е.В., Галушко Е.А., Бочкова А.Г. и др. Клиническое многообразие анкилозирующего спондилита в реальной практике врача-ревматолога в России (часть 1). Науч-прак-тич ревматол 2012;51(2):44-9.</p><p>Van der Heijde D., Baraf H.S., Ramos-Remus C. et al. Evaluation of the efficacy of etoricoxib in ankylosing spondylitis: results of a fifty-two-week, randomized, controlled study. Arthr Rheum 2005;52:1205-15.</p><p>Barkhuizen A., Steinfeld S., Robbins J. et al. Celecoxib is efficacious and well tolerated in treating signs and symptoms of ankylosing spondylitis. J Rheumatol 2006;33:1805-12.</p><p>Sieper J., Klopsch T., Richter M. et al. Comparison of 2 different dosages of celecoxib with diclofenac for the treatment of active ankylosing spondylitis: results of a 12-week randomised doubleblind controlled study. Ann Rheum Dis 2008;67(3):323.</p><p>Ramey D.R., Watson D.J., Yu C. et al. The incidence of upper gastrointestinal adverse events in clinical trials of etoricoxib vs. non-selective NSAIDs: an updated combined analysis. Curr Med Res Opin 2005;21:715-22.</p><p>Hunt R.H., Harper S., Watson D.J. et al. The gastrointestinal safety of the COX-2 selective inhibitor etoricoxib assessed by both endoscopy and analysis of upper gastrointestinal events. Am J Gastroenterol 2003;98(8):1725-33.</p><p>Collantes E., Zarco1 P., Munoz E. et al. Disease pattern of spondyloarthropathies in Spain: description of the first national registry (REGISPONSER) extended report. Rheumatology 2007;46:1309-15.</p><p>Vander Cruyssen B., Ribbens C., Boonen A. et al. The epidemiology of ankylosing spondylitis and the commencement of anti-TNF therapy in daily rheumatology practice. Ann Rheum Dis 2007;66:1072-7.</p><p>Clegg D.O., Reda D.J., Weisman M.H. et al. Comparison of sulfasalazine and placebo in the treatment of ankylosing spondylitis. A department of veterans affairs cooperative study. Arthr Rheum 1996;39(12):2004-12.</p><p>Schmidt W.A., Wierth S., Milleck D. et al. Sulfasalazine in ankylosing spondylitis: a prospective, randomized, double-blind placebo-controlled study and comparison with other controlled studies. Z Rheumatol 2002;61(2):159-67.</p><p>Chen J., Liu C. Is sulfasalazine effective in ankylosing spondylitis? A systematic review of randomized controlled trials. J Rheumatol 2006;33(4):722-31.</p><p>Chen J., Liu C., Lin J. Methotrexate for ankylosing spondylitis. Cochrane Database Syst Rev 2006 Oct 18;(4):CD004524.</p><p>Gonzalez-Lopez L., Garcia-Gonzalez A., Vazquez-Del-Mercado M. et al. Efficacy of methotrexate in ankylosing spondylitis: a randomized, double blind, placebo controlled trial. J Rheumatol 2004;31(8):1568-74.</p><p>Van der Heijde D., Dijkmans B., Geusens P. et al. Efficacy and safety of infliximab in patients with ankylosing spondylitis: results of a randomized, placebo-controlled trial (ASSERT). Arthr Rheum 2005;52(2):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, randomized, double blind, placebo-controlled trial. Arthr Rheum 2006;54:2136-46.</p><p>Davis J.C. Jr, van der Heijde D., Braun J. et al. Recombinant human tumor necrosis factor receptor (etanercept) for treating ankylosing spondylitis: a randomized, controlled trial. Arthr Rheum 2003;48:3230-6.</p><p>Pham T., Landewe R.B., van der Linden S. et al. An International Study on Starting TNF-blocking agents in Ankylosing Spondylitis (ISSAS). Ann Rheum Dis 2006;65:1620-5.</p><p>Landewe R., Rump B., van der Heijde D., van der Linden S. Which patients with ankylosing spondylitis should be treated with tumour necrosis factor inhibiting therapy? A survey among Dutch rheumatologists. Ann Rheum Dis 2004;63:530-4.</p></div><br /><div><p>Braun J., van den Berg R., Baraliakos X. et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2011;70:896-904.</p><p>Analay Y., Ozcan E., Karan A. et al. The effectiveness of intensive group exercise on patients with ankylosing spondylitis. Clin Rehabil 2003;17:631-6.</p><p>Dagfinrud H., Kvien T.K., Hagen K.B. Physiotherapy interventions for ankylosing spondylitis. Cochrane Data base Syst Rev 2008(1); CD002822.</p><p>Mihai B., van der Linden S., de Bie R., Stucki G. Experts' beliefs on physiotherapy for patients with ankylosing spondylitis and assessment of their knowledge on published evidence in the field. Results of a questionnaire among international ASAS members. Eura Medicophys 2005;41:149-53.</p><p>Wanders A., Heijde D., Landewe R. et al. Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: a randomized clinical trial. Arthr Rheum 2005;52:1756-65.</p><p>Braun J., Zochling J., Baraliakos X. et al. Efficacy of sulfasalazine in patients with inflammatory back pain due to undifferentiated spondyloarthritis and early ankylosing spondylitis: a multicenter randomised controlled trial. Ann Rheum Dis 2006;65:1147-53.</p><p>Braun J., van der Horst-Bruinsma I.E., Huang F. et al. Clinical efficacy and safety of etanercept versus sulfasalazine in ankylosing spondylitis patients: a randomized, double-blind study (ASCEND Trial). Arthr Rheum 2011;63(3):1543.</p><p>Van der Heijde D., Sieper J., Maksymowych W.P. et al. (Second) Update of the ASAS recommendations on the use of TNF-blockers in ankylosing spondylitis. Arthr Rheum 2009;60(Suppl 10):1790.</p><p>Волнухин Е.В., Галушко Е.А., Бочкова А.Г. и др. Клиническое многообразие анкилозирующего спондилита в реальной практике врача-ревматолога в России (часть 1). Науч-прак-тич ревматол 2012;51(2):44-9.</p><p>Van der Heijde D., Baraf H.S., Ramos-Remus C. et al. Evaluation of the efficacy of etoricoxib in ankylosing spondylitis: results of a fifty-two-week, randomized, controlled study. Arthr Rheum 2005;52:1205-15.</p><p>Barkhuizen A., Steinfeld S., Robbins J. et al. Celecoxib is efficacious and well tolerated in treating signs and symptoms of ankylosing spondylitis. J Rheumatol 2006;33:1805-12.</p><p>Sieper J., Klopsch T., Richter M. et al. Comparison of 2 different dosages of celecoxib with diclofenac for the treatment of active ankylosing spondylitis: results of a 12-week randomised doubleblind controlled study. Ann Rheum Dis 2008;67(3):323.</p><p>Ramey D.R., Watson D.J., Yu C. et al. The incidence of upper gastrointestinal adverse events in clinical trials of etoricoxib vs. non-selective NSAIDs: an updated combined analysis. Curr Med Res Opin 2005;21:715-22.</p><p>Hunt R.H., Harper S., Watson D.J. et al. The gastrointestinal safety of the COX-2 selective inhibitor etoricoxib assessed by both endoscopy and analysis of upper gastrointestinal events. Am J Gastroenterol 2003;98(8):1725-33.</p><p>Collantes E., Zarco1 P., Munoz E. et al. Disease pattern of spondyloarthropathies in Spain: description of the first national registry (REGISPONSER) extended report. Rheumatology 2007;46:1309-15.</p><p>Vander Cruyssen B., Ribbens C., Boonen A. et al. The epidemiology of ankylosing spondylitis and the commencement of anti-TNF therapy in daily rheumatology practice. Ann Rheum Dis 2007;66:1072-7.</p><p>Clegg D.O., Reda D.J., Weisman M.H. et al. Comparison of sulfasalazine and placebo in the treatment of ankylosing spondylitis. A department of veterans affairs cooperative study. Arthr Rheum 1996;39(12):2004-12.</p><p>Schmidt W.A., Wierth S., Milleck D. et al. Sulfasalazine in ankylosing spondylitis: a prospective, randomized, double-blind placebo-controlled study and comparison with other controlled studies. Z Rheumatol 2002;61(2):159-67.</p><p>Chen J., Liu C. Is sulfasalazine effective in ankylosing spondylitis? A systematic review of randomized controlled trials. J Rheumatol 2006;33(4):722-31.</p><p>Chen J., Liu C., Lin J. Methotrexate for ankylosing spondylitis. Cochrane Database Syst Rev 2006 Oct 18;(4):CD004524.</p><p>Gonzalez-Lopez L., Garcia-Gonzalez A., Vazquez-Del-Mercado M. et al. Efficacy of methotrexate in ankylosing spondylitis: a randomized, double blind, placebo controlled trial. J Rheumatol 2004;31(8):1568-74.</p><p>Van der Heijde D., Dijkmans B., Geusens P. et al. Efficacy and safety of infliximab in patients with ankylosing spondylitis: results of a randomized, placebo-controlled trial (ASSERT). Arthr Rheum 2005;52(2):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, randomized, double blind, placebo-controlled trial. Arthr Rheum 2006;54:2136-46.</p><p>Davis J.C. Jr, van der Heijde D., Braun J. et al. Recombinant human tumor necrosis factor receptor (etanercept) for treating ankylosing spondylitis: a randomized, controlled trial. Arthr Rheum 2003;48:3230-6.</p><p>Pham T., Landewe R.B., van der Linden S. et al. An International Study on Starting TNF-blocking agents in Ankylosing Spondylitis (ISSAS). Ann Rheum Dis 2006;65:1620-5.</p><p>Landewe R., Rump B., van der Heijde D., van der Linden S. Which patients with ankylosing spondylitis should be treated with tumour necrosis factor inhibiting therapy? A survey among Dutch rheumatologists. Ann Rheum Dis 2004;63:530-4.</p></div><br />

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