rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2020-15-21rsp-2837Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHДегенеративные и воспалительные изменения в суставах кистей при остеоартрите по данным магнитно-резонансной томографииDegenerative and inflammatory hand joint changes in osteoarthritis according to magnetic resonance imagingКудинскийД. М.KudinskyD. M.

Данил Маркович Кудинский

15522, Москва, Каширское шоссе, 34А

Danil Kudinsky

34A, Kashirskoe Shosse, Moscow 115522

Jet56@yandex.ruСмирновА. В.SmirnovA. V.

15522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

АлексееваЛ. И.AlekseevaL. I.

15522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

ВолковА. В.VolkovA. V.

15522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

ТаскинаЕ. А.TaskinaE. A.

15522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

ЛилаА. М.LilaА. M.

15522, Москва, Каширское шоссе, 34А; 125993, Москва, ул. Баррикадная, 2/1, стр. 1

34A, Kashirskoe Shosse, Moscow 115522; 2/1, Barrikadnaya St., Build. 1, Moscow 125993

ФГБНУ Научноисследовательский институт ревматологии им. В.А. НасоновойРоссияV.A. Nasonova Research Institute of RheumatologyRussian FederationФГБНУ Научноисследовательский институт ревматологии им. В.А. Насоновой; ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияV.A. Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuing Professional Education, Ministry of Health of RussiaRussian Federation2020190220205811521Copyright © Кудинский Д.М., Смирнов А.В., Алексеева Л.И., Волков А.В., Таскина Е.А., Лила А.М., 20202020Кудинский Д.М., Смирнов А.В., Алексеева Л.И., Волков А.В., Таскина Е.А., Лила А.М.Kudinsky D.M., Smirnov A.V., Alekseeva L.I., Volkov A.V., Taskina E.A., Lila А.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/2837

Эрозивный остеоартрит (ЭОА) суставов кистей (СК) представляет собой фенотип остеоартрита (ОА), который характеризуется наличием центральных и краевых эрозий суставных поверхностей дистальных (ДМФС) и проксимальных (ПМФС) межфаланговых СК и в ряде случаев достаточно агрессивным течением с выраженным болевым синдромом и высокой степенью функциональной недостаточности. Вопрос о диагностических критериях и тактике ведения пациентов с ЭОА до сих пор остается открытым.

Цель исследования — оценить характер изменений, выявляемых при магнитно-резонансной томографии (МРТ) СК у больных ЭОА и неэрозивным ОА (НЭОА) СК.

Материал и методы

Материал и методы. Обследована 61 женщина с соответствующим критериям Американской коллегии ревматологов (АСЯ) диагнозом ОА СК, средний возраст пациенток составил 66,34+5,79 года, медиана возраста начала болезни— 50 [45; 56] лет, длительности боли— 15 [11; 20] лет. Всем пациенткам выполнена МРТ II—VДМФС, ПМФС и пястно-фаланговых суставов (ПФС) правой кисти. Больные также заполнили опросник AUSCAN. У 30 больных выявлен ЭОА, у 31 - НЭОА.

Результаты и обсуждение

Результаты и обсуждение. Пациентки с ЭОА и НЭОА были сопоставимы по полу, возрасту и длительности заболевания. В ДМФС при ЭОА достоверно (p<0,05) чаще и в большем количестве, чем при НЭОА, выявлялись крупные остеофиты (ОФ; 53 и 16%), сужение суставной щели (ССЩ; 73 и 35%), дегенеративные изменения коллатеральных связок (ДИКС; 93 и 55%), подвывихи (47 и 13%), отек костного мозга (ОКМ; 57 и 19%). Синовиты и субхондральные кисты при ЭОА и НЭОА встречались приблизительно с одинаковой частотой. В ПМФС при ЭОА значимо чаще, чем при НЭОА, выявлены ОКМ (37%) и ДИКС (97%). Подвывихи в ПМФС правой кисти встречались исключительно у пациенток с ЭОА. Их частота составила 17%. Симптомы дегенеративного характера (небольшие, реже умеренных размеров ОФ, ССЩ, ДИКС) выявлялись приблизительно с одинаковой частотой в обеих группах (p>0,05). В ПФС у пациенток с ЭОА значимо чаще, чем при НЭОА, выявлялись ОКМ (53 и 26%; p<0,05), кортикальные дефекты (КД) головок пястных костей (73 и 45% соответственно). Частота субхондральных кист, ОФ, ССЩ и ДИКС существенно не различалась в обеих группах (p>0,05). Крупные ОФ в ПФС выявлялись сравнительно редко. Подвывихи в ПФС не были обнаружены ни в одной группе.

Заключение

Заключение. У пациенток с ЭОА, в отличие от больных НЭОА, преобладают симптомы активного воспаления, а также более выражены дегенеративные изменения. Дефекты суставных поверхностей в ПФС при ОА СК отличаются от эрозий при ревматоидном артрите. Эти КД при ЭОА встречаются значимо чаще, чем при НЭОА, однако природа их возникновения не ясна, поэтому пациентки, у которых они обнаружены, нуждаются в динамическом наблюдении.

Erosive osteoarthritis (EOA) of the hand is an osteoarthritis (OA) phenotype that is characterized by central and marginal erosions of the articular surfaces in the distal and proximal interphalangeal (DIP and PIP) joints and in some cases by a fairly aggressive course with obvious pain syndrome and a high level of functional impairment. Diagnostic criteria and management tactics for EOA patients are still under investigation.

Objective

Objective: to evaluate the nature of the changes detected by hand joint magnetic resonance imaging (MRI) in patients with EOA and non-erosive OA (NEOA) of the hand.

Subjects and methods

Subjects and methods. Examinations were made in 61 females meeting the American College of Rheumatology (ACR) diagnostic criteria for hand OA; the patients' mean age was 66.34+5.79 years; the median age at disease onset was 50 [45; 56] years; the duration of pain was 15 [11; 20] years. All the patients underwent MRI of the second-fifth DIP, PIP, and metacarpophalangeal (MCP) joints of the right hand. The patients also filled out the AUSCAN questionnaire. EOA and NEOA were detected in 30 and 31 patients, respectively.

Results and discussion

Results and discussion. The patients with EOA and those with NEOA were matched for gender, age, and disease duration. The DIP joints in patients with EOA were found to have significantly more frequently and a greater number of large osteophytes (OPs), (53 and 16%, respectively), joint space narrowing (JSN) (73 and 35%), degenerative collateral ligament changes (DCLCs) (93 and 55%), subluxations (47 and 13%), and bone marrow edema (BME) (57 and 19%) than in those with NEOA. Synovitides and subchondral cysts occurred with approximately the same frequency in EOA and NEOA. The PIP joints in patients with EOA significantly more frequently showed BME (37%) and DCLCs (97%) than in those with NEOA. Subluxations in the PIP joint of the right hand were encountered exclusively in patients with EOA. Their incidence was 17%. Degenerative symptoms (small, less often moderate sizes of OPs, JSN, and DCLCs) were identified with approximately the same frequency in both groups (p>0.05). The PIP joints in patients with EOA were significantly more often found to have BME (53 and 26%, respectively; (p<0.05), cortical defects (CDs) of the metacarpal head (73 and 45%) than in those with NEOA. The incidence of subchondral cysts, OPs, JSN, and DCLCs was not significantly different in both groups (p>0.05). Large OPs in the PIP joint were found relatively rarely. Subluxations in the PIP joints were undetected in both groups.

Conclusion

Conclusion. The symptoms of active inflammation are predominant and degenerative changes are more pronounced in patients with EOA unlike those with NEOA. Articular surface defects in the PIP joints in patients with hand OA differ from erosions in those with rheumatoid arthritis. These CDs in EOA are much more common than those in NEOA; however, the nature of their occurrence is unclear; therefore, the patients in whom they have been found need dynamic monitoring.

остеоартритмагнитно-резонансная томография суставов кистейдистальные межфаланговые суставыпроксимальные межфаланговые суставыпястно-фаланговые суставысужение суставной щелиаостеофитыотек костного мозгаколлатеральные связкиosteoarthritismagnetic resonance imaging of hand jointsdistal interphalangeal jointsproximal interphalangeal jointsmetacarpophalangeal jointsjoint space narrowingosteophytesbone marrow edemacollateral ligamentsReferencesACR. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum. 2000 Sep;43(9):1905-15. doi: 10.1002/1529-0131(200009)43:9<1905::AID-ANR1>3.0.CO;2-PACR. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. 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The authors declare that there are no conflicts of interest present.