References

rsp

Научно-практическая ревматология

Rheumatology Science and Practice

1995-44841995-4492

IMA-PRESS, LLC

10.14412/1995-4484-2014-283-289

rsp-1940

Research Article

ОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ

ORIGINAL RESEARCH

Коморбидность при ревматоидном артрите

COMORBIDITY IN RHEUMATOID ARTHRITIS

Панафидина

Т. А.

Panafidina

T. A.

panafidina@inbox.ru

Кондратьева

Л. В.

Kondratyeva

L. V.

Герасимова

Е. В.

Gerasimova

E. V.

Новикова

Д. С.

Novikova

D. S.

Попкова

Т. В.

Popkova

T. V.

ФГБУ «Научно- исследовательский институт ревматологии им. В.А. Насоновой» РАН, Москва, РоссияРоссияNasonova Research Institute of Rheumatology, Moscow, RussiaRussian Federation

2014

20062014

523

№3 (2014)

283289

2014

Панафидина Т.А., Кондратьева Л.В., Герасимова Е.В., Новикова Д.С., Попкова Т.В.

Panafidina T.A., Kondratyeva L.V., Gerasimova E.V., Novikova D.S., Popkova T.V.

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/1940

Пик начала ревматоидного артрита (РА) приходится на 30–55 лет. В этом возрасте пациенты имеют и другие сопутствующие (коморбидные) заболевания, которые оказывают влияние на течение и прогноз РА, выбор тактики лечения и качество жизни больных. Цель настоящего исследования – выявить наиболее значимые и часто встречающиеся коморбидные состоя- ния у пациентов с РА. Материал и методы. Включено 200 пациентов в возрасте 55 [46; 61] лет, преобладали женщины (82,5%), с дли- тельным течением заболевания (5 [1; 10] лет), серопозитивные по IgM ревматоидному фактору (83,0%) и ан- тителам к циклическому цитруллинированному пептиду (81,6%), с умеренной и высокой клинической актив- ностью болезни (DAS28=3,9 [3,1; 4,9]). У 71,2% пациентов рентгенологически выявлялись деструктивные из- менения суставов кистей или стоп различной степени выраженности, 64,5% больных имели II функциональ- ный класс. Основным базисным противовоспалительным препаратом (БПВП) был метотрексат, его получали 69,5% пациентов, терапия генно-инженерными биологическими препаратами (ГИБП) применялась в 21,0% случаев. 15,5% пациентов не получали БПВП и ГИБП. Глюкокортикоиды принимали 43,0% больных РА. Результаты. Сопутствующие заболевания имели 72,0% пациентов с РА. Чаще всего встречалась артериальная гипертензия (АГ; 60,0%), дислипидемия (ДЛП; 45,0%), переломы разной локализации (29,5%) и ишемиче- ская болезнь сердца (21,0%). Инфаркт миокарда и инсульт наблюдались в 1,5 и 1,0% случаев соответственно. Сахарный диабет (СД) выявлен в 7,5% случаев, остеопороз – у 15,5% пациентов. 81,7% пациентов с РА и АГ и 80,0% пациентов с РА и СД получали гипотензивную и сахароснижающую терапию соответственно. В то же время больные РА, имеющие ДЛП и остеопороз, принимали специфические препараты гораздо реже (30,0 и 29,0% соответственно). Выводы. Коморбидные состояния при РА встречаются часто. Учитывая, что кардиоваскулярные заболевания являются основной причиной летальности при РА, необходимо адекватно и своевременно корректировать традиционные факторы риска (АГ, ДЛП, СД). Курация больных РА требует междисциплинарного подхода и взаимодействия между врачами разных специальностей.

The peak onset of rheumatoid arthritis (RA) is at 30-55 years of age. At this age, the patients have also other concomi- tant diseases (comorbidities) that affect the course and prognosis of RA, the choice of its treatment policy, quality of life of the patients. Objective: to identify the most important and common comorbidities in patients with RA. Subjects and methods. Two hundred patients (median age 55 [46; 61] years) were enrolled; there was a preponderance of women (82.5%) with median disease duration 5 [1; 10] years, seropositive for IgM rheumatoid factor (83.0%) and anti-cyclic citrullinated peptide antibodies (81.6%) with moderate and high disease activity (median DAS28 value 3.9 [3.1; 4.9]). Varying degrees of destructive changes in hand and foot joints were radiologically detected in 71.2% of the patients; 64.5% of the patients had Functional Class II. Methotrexate was given to 69.5% of the patients; therapy with biological agents was used in 21.0% of the cases. 15.5% of the patients did not receive DMARD or biologics. 43.0% of the patients with RA received glucocorticoids. Results. Comorbidities were present in 72.0% of the patients with RA. The most common diseases were hypertension (60.0%), dyslipidemia (45.0%), fractures at various sites (29.5%), and coronary heart disease (21.0%). Myocardial infarction and stroke were observed in 1.5 and 1.0% of cases, respectively. There was diabetes mellitus (DM) in 7.5% of the cases and osteoporosis in 15.5% of the patients. 81.7% of the patients with RA and hypertension and 80.0% of those with RA and DM received antihypertensive and sugar-lowering therapy, respectively. At the same time the RA patients with dyslipidemia and osteoporosis received specific drugs far less frequently (30.0 and 29.0%, respectively). Conclusion. Comorbidities are frequently encountered in RA. By taking into account the fact that cardiovascular dis- eases are a main cause of death in RA; it is necessary to adequately and timely modify traditional risk factors (hyper- tension, dyslipidemia, and diabetes mellitus). Treatment patients with RA requires an interdisciplinary approach and an interaction between physicians of different specialties.

ревматоидный артритсопутствующие (коморбидные) заболеванияартериальная гипер- тензиядислипидемиясахарный диабетишемическая болезнь сердцаостеопороз.

rheumatoid arthritisconcurrent diseases (comorbidities)hypertensiondyslipidemiadiabetes mellituscoronary heart diseaseosteoporosis.

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