References

rsp

Научно-практическая ревматология

Rheumatology Science and Practice

1995-44841995-4492

IMA-PRESS, LLC

10.14412/1995-4484-2013-1199

rsp-1109

Research Article

Статьи

Articles

Оценка эффективности терапии тоцилизумабом у пациентов с ревматоидным артритом по данным ультразвукового исследования и рентгенографии

EVALUATION OF THE EFFICIENCY OF TOCILIZUMAB THERAPY IN PATIENTS WITH RHEUMATOID ARTHRITIS BY ULTRASOUND AND X-RAY DATA

Осипянц

Р. А.

Osipyants

Rita Aleksandrovna

pchelka_maya.07@mail.ru

Каратеев

Д. Е.

Karateev

D E

Панасюк

Е. Ю.

Panasyuk

E Yu

Лукина

Г. В.

Lukina

G V

Смирнов

А. В.

Smirnov

A V

Глухова

С. И.

Glukhova

S I

Александрова

Е. Н.

Aleksandrova

E N

Волков

А. В.

Volkov

A V

Насонов

Е. Л.

Nasonov

E L

Федеральное государственное бюджетное учреждение «Научно-исследовательский институт ревматологии» РАМН, Москва

2013

15022013

511

№1 (2013)

3843

2013

Осипянц Р.А., Каратеев Д.Е., Панасюк Е.Ю., Лукина Г.В., Смирнов А.В., Глухова С.И., Александрова Е.Н., Волков А.В., Насонов Е.Л.

Osipyants R.A., Karateev D.E., Panasyuk E.Y., Lukina G.V., Smirnov A.V., Glukhova S.I., Aleksandrova E.N., Volkov A.V., Nasonov E.L.

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/1109

Цель оценить динамику ультразвуковых признаков синовита суставов запястий у пациентов с ревматоидным артритом (РА) на фоне лечения тоцилизумабом (ТЦЗ) и возможность прогнозировать прогрессирование рентгенологических изменений суставов при помощи ультразвукового исследования (УЗИ). Материал и методы. В исследование вошли 46 пациентов с диагнозом РА, соответствующим критериям Американской коллегии ревматологов 1987 г. Всем больным назначался ТЦЗ на фоне недостаточно эффективной предшествующей терапии (медиана DAS28 6,7 [5,9; 7,2]). Они были разделены на две группы: 1-я — ранний РА (РРА) с продолжительностью болезни до 2 лет (n=11); 2-я РА с длительностью >2 лет (n=35). УЗИ кистей (Voluson-i, GE, США; линейным датчиком 4-13 МГц) с использованием энергетического допплера (ЭД) осуществлялось исходно и после 6 мес терапии. Структурные изменения оценивались с помощью рентгенографии кистей и стоп (исходно и после 12 мес наблюдения) по методу Шарпа в модификации ван дер Хейде. Результаты. Динамическая оценка ультразвуковых признаков воспаления показала достоверное уменьшение выраженности синовита по данным «серой» шкалы в обеих группах, а в режиме ЭД только у пациентов с РРА. Наблюдалась четкая ассоциация годового прироста рентгенологических изменений суставов с результатом оценки выраженности синовита по данным ЭД (r=0,669; р<0,01). Заключение. Сонография суставов запястий позволяет оценить эффективность проводимой терапии у пациентов с РА, а наличие синовита умеренной или значимой степени по данным ЭД является предиктором прогрессирования деструкции суставов.

Objective: to estimate the time course of changes in the ultrasound signs of wrist joint synovitis in patients with rheumatoid arthritis (RA) during tocilizumab (TCZ) treatment and to determine whether the progression of joint X-ray changes can be predicted by ultrasonography (USG). Subjects and methods. The investigation enrolled 46 patients with the diagnosis of RA that met the American College of Rheumatology 1987 criteria. All the patients were given TCZ during insufficiently effective previous therapy (median DAS28 was 6.7 [range 5.9—7.2]). They were divided into 2 groups: 1) early RA (ERA) with a disease history of less than 2 years (n = 11); 2) RA with a history of over 2 years (n = 35). Hand USG (Voluson-i GE, USA) with a 4—13-MHz linear probe using an energy Doppler (ED) was carried out before and 6 months after therapy. Structural changes were evaluated by hand and foot X-ray study (before and at 12-month follow-up) according to the Sharp method modified by van der Heide. Results. Dynamic evaluation of the ultrasound signs of inflammation indicated a significant reduction in the magnitude of synovitis in accordance with the gray-scale data in both groups and only in the patients with ERA in the ED mode. There was a clear association of the annual increment in joint X-ray changes with the result of estimation of the magnitude of synovitis according to the ED data (r = 0.669; p < 0.01). Conclusion. Wrist joint sonography allows evaluation of the efficiency of the performed therapy in patients with RA and the presence of moderate or severe synovitis, as evidenced by ED, is a predictor for the progression of joint destruction.

ультрасонография кистейревматоидный артритструктурное прогрессированиевоспалительная активностьтоцилизумаб

hand ultrasonographyrheumatoid arthritisstructural progressioninflammatory activitytocilizumab

References1

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