rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2019-528-531rsp-2786Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHСочетание болезни Бехчета с аксиальным спондилоартритом: собственные наблюденияBehcet's disease concurrent with axial spondyloarthritis: the authors' own observationsАлекбероваЗ. С.AlekberovaZ. S.

115522, Москва, Каширское шоссе, 34А.

34A, Kashirskoe Shosse, Moscow.

ДубининаТ. В.DubininaT. V.

Дубинина Татьяна Васильевна.

115522, Москва, Каширское шоссе, 34А.

Tatiana Dubinina.

34A, Kashirskoe Shosse, Moscow.

omsi@irramn.ruГолоеваР. Г.GoloevaR. G.

115522, Москва, Каширское шоссе, 34А.

34A, Kashirskoe Shosse, Moscow.

АгафоноваЕ. М.AgafonovaE. M.

115522, Москва, Каширское шоссе, 34А.

34A, Kashirskoe Shosse, Moscow.

ЛилаА. М.LilaA. M.

115522, Москва, Каширское шоссе, 34А; 125993, Москва, ул. Баррикадная, 2/1, стр. 1.

34A, Kashirskoe Shosse, Moscow; 15522; 2/1, Barrikadnaya St., Build. 1, Moscow 125993.

Научно-исследовательский институт ревматологии им. В.А. НасоновойРоссияV.A. Nasonova Research Institute of RheumatologyRussian FederationНаучно-исследовательский институт ревматологии им. В.А. Насоновой; Российская медицинская академия непрерывного профессионального образования Минздрава РоссииРоссияV.A. Nasonova Research Institute of Rheumatology; Medical Academy of Continuing Professional Education, Ministry of Health of RussiaRussian Federation201916112019575528531Copyright © Алекберова З.С., Дубинина Т.В., Голоева Р.Г., Агафонова Е.М., Лила А.М., 20192019Алекберова З.С., Дубинина Т.В., Голоева Р.Г., Агафонова Е.М., Лила А.М.Alekberova Z.S., Dubinina T.V., Goloeva R.G., Agafonova E.M., Lila A.M.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/2786

Цель исследования – представить случаи сочетания болезни Бехчета (ББ) с аксиальным спондилоартритом (аксСпА).

Материал и методы

Материал и методы. За период с 1990 по 2018 г. в ФГБНУ  НИИР им. В.А. Насоновой было обследовано 470 пациентов с ББ, удовлетворявших критериям ISGBD.  У 9 из них ББ сочеталась с аксСпА; 7 из 9 соответствовали модифицированным Нью-Йоркским критериям анкилозирующего спондилита  (АС) 1984 г. и двое – критериям нерентгенологического аксСпА ASAS 2009 г.

Результаты и обсуждение

Результаты и обсуждение. Большинство пациентов были мужчины (55,6%). У 6 пациентов ББ предшествовала аксСпА. Симптомы АС присоединились в среднем через 8,4 [2; 10] года от возникновения клинических проявлений ББ. У трех пациентов ББ развилась через 9–15 лет от появления первых симптомов  аксСпА. Средняя  продолжительность ББ составила 14,0±7,8  года, а аксСпА – 10,9±6,2  года. Все пациенты  были позитивными по HLA-B27, у трех был выявлен  B5-антиген. Все 9 пациентов имели слизисто-кожные проявления, характерные  для ББ. У 4 больных диагностировано поражение  глаз: генерализованный увеит с ангиитом сетчатки, задний увеит с ангиитом сетчатки или без него. В 44,4% случаев обнаружено  поражение  желудочно-кишечного тракта. Периферический артрит был у всех пациентов. Вовлечение  энтезисов  отмечено у 66,7% больных. Рентгенологические признаки двустороннего  сакроилиита, соответствующего модифицированным  Нью-Йоркским критериям, были выявлены  у 7 (77,8%), активные  воспалительные изменения в области крестцово-подвздошных суставов по данным МРТ – у 3 (33,3%) больных.

Заключение

Заключение. В повседневной клинической практике  необходимо  учитывать возможность перекреста  между ББ и аксСпА,  что будет способствовать выбору оптимальной стратегии лечения.

Objective

Objective: to present cases of Behcet's disease (BD) concurrent  with axial spondyloarthritis  (axSpA).

Subjects and methods

Subjects and methods. A total of 470 patients with BD who met the International Standard Bibliographic Description (ISBD) criteria were examined at the V.A. Nasonova Research Institute of Rheumatology in the period from 1990 to

2018

2018. In 9 of them, BD was concurrent  with axSpA; 7 out of the 9 patients met the 1984 modified New York criteria for ankylosing spondylitis (AS) and two patients fulfilled the 2009 ASAS non-radiographic axSpA criteria.

Results and discussion

Results and discussion. Most (55.6%) patients were men. BD was preceded by axSpA in 6 patients. The symptoms of AS joined an average of 8.4 [2; 10] years after the onset of the clinical manifestations of BD. Three patients developed BB 9–15 years after the onset of the first symptoms of axSpA. The mean duration  of BD was 14.0±7.8 years and that of axSpA was 10.9±6.2  years. All the patients were HLA-B27-positive; three were found to have B5 antigen.All the 9 patients had mucocutaneous manifestations  that were characteristic  of BD. Four patients were diagnosedas having eye injuries: generalized uveitis with retinal vasculitis, posterior uveitis with or without retinal vasculitis. Gastrointestinal tract lesions were detected in 44.4% of cases. Peripheral  arthritis was present in all the patients. Entheseal involvement was observed in 66.7% of patients. The radiographic signs of bilateral sacroiliitis according to the modified New York criteria were found in 7 (77.8%) patients; MRI revealed active inflammatory changes in the area of the sacroiliac joint in 3 (33.3%) patients.

Conclusion

Conclusion. The fact that there may be an overlap between BD and axSpA should be taken into account in everyday clinical practice, which will assist in choosing the optimal treatment strategy.

болезнь Бехчетааксиальный спондилоартританкилозирующий спондилитспондилоартритыBehcet's diseaseaxial spondylitisankylosing spondylitisspondyloarthritidesReferencesMoll JM, Haslock I, Macrae IF, Wright V. Associations between ankylosing spondylitis, psoriatic arthritis, Reiter's disease, the intestinal arthropathies, and Behcet's syndrome. Medicine (Baltimore). 1974 Sep;53(5):343-64. doi: 10.1097/00005792-197409000-00002Moll JM, Haslock I, Macrae IF, Wright V. Associations between ankylosing spondylitis, psoriatic arthritis, Reiter's disease, the intestinal arthropathies, and Behcet's syndrome. Medicine (Baltimore). 1974 Sep;53(5):343-64. doi: 10.1097/00005792-197409000-00002Rudwaleit M, van der Heijde D, Landewe R, еt аl. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68:777-83. doi: 10.1136/ard.2009.108233Rudwaleit M, van der Heijde D, Landewe R, еt аl. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68:777-83. doi: 10.1136/ard.2009.108233Schoels MM, Braun J, Dougados M, et al. Treating axial and peripheral spondyloarthritis, including psoriatic arthritis, to target: results of a systematic literature search to support an international treat-to-target recommendation in spondyloarthritis. Ann Rheum Dis. 2014;73(1):238-42. doi: 10.1136/annrheumdis-2013-203860Schoels MM, Braun J, Dougados M, et al. Treating axial and peripheral spondyloarthritis, including psoriatic arthritis, to target: results of a systematic literature search to support an international treat-to-target recommendation in spondyloarthritis. Ann Rheum Dis. 2014;73(1):238-42. doi: 10.1136/annrheumdis-2013-203860Jennette JC, Falk RJ, Bacon PA, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013;65(1):1-11. doi: 10.1007/978-3-319-40136-2-3Jennette JC, Falk RJ, Bacon PA, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013;65(1):1-11. doi: 10.1007/978-3-319-40136-2-3Fominykh V, Shevtsova T, Arzumanian N, Brylev L. Coexistence of multiple sclerosis and ankylosing spondylitis: Report of four cases from Russia and review of the literature. J Clin Neurosci. 2017;44:230-3. doi: 10.1016/j.jocn.2017.06.031Fominykh V, Shevtsova T, Arzumanian N, Brylev L. Coexistence of multiple sclerosis and ankylosing spondylitis: Report of four cases from Russia and review of the literature. J Clin Neurosci. 2017;44:230-3. doi: 10.1016/j.jocn.2017.06.031Chang HK, Lee DH, Jung SM, et al. The comparison between Behcet's disease and spondyloarthritides: does Behcet's disease belong to the spondyloarthropathy complex? J Korean Med Sci. 2002;17(4):524-9. doi: 10.3346/jkms.2002.17.4.524Chang HK, Lee DH, Jung SM, et al. The comparison between Behcet's disease and spondyloarthritides: does Behcet's disease belong to the spondyloarthropathy complex? J Korean Med Sci. 2002;17(4):524-9. doi: 10.3346/jkms.2002.17.4.524McGonagle D, Aydin SZ, Gü l A, et al. 'MHC-I-opathy'-unified concept for spondyloarthritis and Behcet disease. Nat Rev Rheumatol. 2015;11(12):731-40. doi: 10.1038/nrrheum.2015.147McGonagle D, Aydin SZ, Gü l A, et al. 'MHC-I-opathy'-unified concept for spondyloarthritis and Behcet disease. Nat Rev Rheumatol. 2015;11(12):731-40. doi: 10.1038/nrrheum.2015.147Алекберова ЗС. Болезнь Бехчета (лекция). Научно-практическая ревматология. 2013;51(1):52-8. doi: 10.14412/1995-4484-2013-1202Alekberova ZS. Behcet's disease (a lecture). Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2013;51(1):52-8 (In Russ.). doi: 10.14412/1995-4484-2013-1202Van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984;27:361-8. doi: 10.1002/art.1780270401Van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984;27:361-8. doi: 10.1002/art.1780270401Kardes S, Karagü lle M, Karagü lle M.Z, Erdogan N. Coexistence of Behcet's disease and ankylosing spondylitis: case report and review of the literature. Acta Medica Mediterranea. 2016;32(4):947-51. doi: 10.19193/0393-6384-2016-4-114Kardes S, Karagü lle M, Karagü lle M.Z, Erdogan N. Coexistence of Behcet's disease and ankylosing spondylitis: case report and review of the literature. Acta Medica Mediterranea. 2016;32(4):947-51. doi: 10.19193/0393-6384-2016-4-114Sieper J, van der Heijde DM, Landewe RBM, 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. 2008;68(6):784-8. doi: 10.1136/ard.2008.101501Sieper J, van der Heijde DM, Landewe RBM, 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. 2008;68(6):784-8. doi: 10.1136/ard.2008.101501Kotevoglu N, Tasbas I, Bekiroglu N. Computed tomography does not support sacroiliitis as a feature of Behcet disease: A metaanalytic review. J Clin Rheumatol. 2004;10:42-5. doi: 10.1097/01.rhu.0000111298.67743.08Kotevoglu N, Tasbas I, Bekiroglu N. Computed tomography does not support sacroiliitis as a feature of Behcet disease: A metaanalytic review. J Clin Rheumatol. 2004;10:42-5. doi: 10.1097/01.rhu.0000111298.67743.08Sieper J, Rudwaleit M, Baraliakos X, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: A guide to assess spondyloarthritis. Ann Rheum Dis. 2009;68:ii1-ii44. doi: 10.1136/ard.2008.104018Sieper J, Rudwaleit M, Baraliakos X, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: A guide to assess spondyloarthritis. Ann Rheum Dis. 2009;68:ii1-ii44. doi: 10.1136/ard.2008.104018Годзенко АА, Бочкова АГ, Румянцева ОА и др. Течение и исходы увеита у больных анкилозирующим спондилитом. Научно-практическая ревматология. 2014;52(5):520-5. doi: 10.14412/1995-4484-2014-520-525Godzenko AA, Bochkova AG, Rumyantseva OA, et al. Progression and outcomes of uveitis in patients with ankylosing spondylitis. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2014;52(5):520-5 (In Russ.). doi: 10.14412/1995-4484-2014-520-525Kirino Y, Bertsias G, Ishigatsubo Y, et al. Genome-wide association analysis identifies new susceptibility loci for Behcet's disease and epistasis between HLA-B*51 and ERAP1. Nat Genet. 2013;45(2):202-7. doi: 10.1038/ng.2520Kirino Y, Bertsias G, Ishigatsubo Y, et al. Genome-wide association analysis identifies new susceptibility loci for Behcet's disease and epistasis between HLA-B*51 and ERAP1. Nat Genet. 2013;45(2):202-7. doi: 10.1038/ng.2520Гайдукова ИЗ, Ребров АП, Лапшина СА и др. Применение нестероидных противовоспалительных препаратов и генно-инженерных биологических препаратов для лечения аксиальных спондилоартритов. Рекомендации Экспертной группы по изучению спондилоартритов при Общероссийской общественной организации «Ассоциация ревматологов России». Научно-практическая ревматология. 2017;55(5):474-48. doi: 10.14412/1995-4484-2017-474-484Gaidukova IZ, Rebrov AP, Lapshina SA, et al. Use of nonsteroidal anti-inflammatory drugs and biological agents for the treatment of axial spondyloarthritides. Recommendations of the Spondyloarthritis Study Group of Experts, All-Russian Public Organization «The Association of Rheumatology of Russia». Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2017;55(5):474-84 (In Russ.). doi: 10.14412/1995-4484-2017-474-484Vallet H, Riviere S, Sanna A, Deroux A. Efficacy of anti-TNF alpha in severe and/or refractory Behсet's disease: Multicenter study of 124 patients. Efficacy of anti-TNF alpha in severe and/or refractory Behcet's disease: Multicenter study of 124 patients. J Autoimmun. 2015;62:67-74. doi: 10.1016/j.jaut.2015.06.005Vallet H, Riviere S, Sanna A, Deroux A. Efficacy of anti-TNF alpha in severe and/or refractory Behсet's disease: Multicenter study of 124 patients. Efficacy of anti-TNF alpha in severe and/or refractory Behcet's disease: Multicenter study of 124 patients. J Autoimmun. 2015;62:67-74. doi: 10.1016/j.jaut.2015.06.005Atas N, Babaoglu H, Varan O, Tufan A. Duration of anti-TNF treatment in vascular Behcet's disease: better to prolong treatment? Clin Exp Rheumatol. 2018;36(6 Suppl 115):147.Atas N, Babaoglu H, Varan O, Tufan A. Duration of anti-TNF treatment in vascular Behcet's disease: better to prolong treatment? Clin Exp Rheumatol. 2018;36(6 Suppl 115):147.Yildiz N, Alkan H, Ardic F, Topuz O. Successful treatment with adalimumab in a patient with coexisting Behcet's disease and ankylosing spondylitis. Rheumatol Int. 2010;30:1511-4. doi: 10.1007/s00296-009-1104-3Yildiz N, Alkan H, Ardic F, Topuz O. Successful treatment with adalimumab in a patient with coexisting Behcet's disease and ankylosing spondylitis. Rheumatol Int. 2010;30:1511-4. doi: 10.1007/s00296-009-1104-3Ordahan B, Karahan AY, Dogan SC, et al. Infliximab treatment in co-existing Behcet's disease and ankylosing spondylitis case presentation. J Rheumatol Orthop. 2014;1:2. doi: 10.7243/2055-7000-1-2Ordahan B, Karahan AY, Dogan SC, et al. Infliximab treatment in co-existing Behcet's disease and ankylosing spondylitis case presentation. J Rheumatol Orthop. 2014;1:2. doi: 10.7243/2055-7000-1-2

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