rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2014-91-98rsp-1688Research ArticleСтатьиArticlesКожный васкулит у больных ревматоидным артритомCUTANEOUS VASCULITIS IN PATIENTS WITH RHEUMATOID ARTHRITISБестаевД.В.BestaevDavid Vladimirovidavidbestaev@rambler.ruКаратеевД.Е.KarateevD EФГБУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой» РАМН, Москва, РоссияРоссияV.A. Nasonova Research Institute of Rheumatology, Russian Academy of Medical Sciences, Moscow, RussiaRussian Federation2014260320145219198Copyright © Бестаев Д.V., Каратеев Д.E., 20142014Бестаев Д., Каратеев Д.Bestaev D.V., Karateev D.E.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/1688

Ревматоидный артрит (РА) представляет собой хроническое аутоиммунное заболевание, характеризующееся воспалительно-деструктивным поражением суставов и внесуставными проявлениями с вовлечением в патологический процесс различных органов и систем. Одним из системных проявлений РА является кожный ревматоидный васкулит (РВ). К факторам, предрасполагающим к развитию РВ при РА, относятся мужской пол, высокие титры ревматоидного фактора (РФ), антител к циклическому цитруллинированному пептиду (АЦЦП), антинейтрофильных цитоплазматических антител и наличие других внесуставных проявлений. Развитие РВ может быть связано с отложением иммунных комплексов в стенках сосудов. Активность РВ коррелирует с высоким уровнем РФ, АЦЦП, антиядерных антител. Классическими признаками РВ являются периферическая гангрена, множественный мононеврит, а также склерит, перикардит и поражение легких. Однако чаще встречается поражение кожи: инфаркты околоногтевого ложа (дигитальный артериит), капилляриты, сетчатое ливедо и хронические язвы голени. Развитие РВ ухудшает прогноз заболевания. До того как в клиническую практику были внедрены принципы раннего назначения и использования базисных противовоспалительных препаратов, 5-летняя выживаемость больных РВ составляла 28–40%. РВ не является самостоятельным заболеванием и в подавляющем большинстве случаев сам по себе угрозы для больного не представляет и лечения не требует. Специальное лечение по поводу кожного васкулита требуется только при наличии трофических язв. В статье рассмотрены вопросы патогенеза, тактики лечения РВ у больных РА.

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammatory and destructive joint damage and extra-articular manifestations involving various organs and systems in the pathological process. One of systemic manifestations of RA is cutaneous rheumatoid vasculitis (RV). Factors predisposing to the development of RV in RA patients include male gender, high titers of rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) antibodies, antineutrophil cytoplasmic antibodies, and presence of other extra-articular manifestations. RV may develop due to immune complex deposition on the vascular walls. RV activity correlates with high level of RF, anti-CCP and anti-nuclear antibodies. The typical signs of RV include peripheral gangrene, mononeuritis multiplex, as well as scleritis, pericarditis and lung damage. However, skin lesions, such as periungual infarction (digital arteritis), capillaritis, livedo reticularis, and chronic leg ulcers, are more common signs. Development of RV worsens the prognosis of the disease. The 5-year survival rate of RV patients was 28–40% until the principle of early administration of basic anti-inflammatory drugs was implemented. RV is not an independent disease; in most cases, RV alone does not impose a threat to a patient and requires no treatment. Special treatment of cutaneous vasculitis is required in case of venous ulcers only. The article discusses the pathogenesis issues and strategies of RV treatment in RA patients.

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