rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2022-465-472rsp-3201Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHКлинико-инструментальная характеристика поражения позвоночника при псориатическом артрите в реальной клинической практикеClinical and instrumental characteristics of axial involvement in psoriatic arthritis in real-life clinical practicehttps://orcid.org/0000-0001-5015-7143ГубарьЕ. Е.GubarE. E.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

gubarelena@yandex.ruhttps://orcid.org/0000-0003-0579-1131КоротаеваТ. В.KorotaevaT. V.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0001-5968-2403КорсаковаЮ. Л.KorsakovaYu. L.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0001-6875-4552ЛогиноваЕ. Ю.LoginovaE. Yu.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0001-7418-9369СмирновА. В.SmirnovA. V.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0003-1505-7563СухининаА. В.SukhininaA. V.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-9755-5760УрумоваМ. М.UrumovaM. M.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-4285-0869ГлуховаС. И.GlukhovaS. I.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation202207092022604465472Copyright © Губарь Е.Е., Коротаева Т.В., Корсакова Ю.Л., Логинова Е.Ю., Смирнов А.В., Сухинина А.В., Урумова М.М., Глухова С.И., 20222022Губарь Е.Е., Коротаева Т.В., Корсакова Ю.Л., Логинова Е.Ю., Смирнов А.В., Сухинина А.В., Урумова М.М., Глухова С.И.Gubar E.E., Korotaeva T.V., Korsakova Y.L., Loginova E.Y., Smirnov A.V., Sukhinina A.V., Urumova M.M., Glukhova S.I.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/3201

Цель исследования – оценить клинико-инструментальные характеристики поражения позвоночника при псориатическом артрите (ПсА) в реальной клинической практике.

Материал и методы

Материал и методы. Обследовано 52 больных ПсА (32 мужчины и 20 женщин) с наличием на момент включения и/или в анамнезе боли в позвоночнике. Наличие воспалительной боли в спине (ВБС) определялось по критериям ASAS (Assessment in SpondyloArthritis International Society). Боль в спине длительностью более трех месяцев, не соответствовавшую критериям ВБС, считали хронической болью в спине (хр-БС). Выполняли рентгенографию кистей, стоп, таза, шейного (ШОП) и поясничного (ПОП) отделов позвоночника. Оценивали эрозии, остеолиз, околосуставные остеопролиферации; использовали модифицированный для ПсА счет Шарпа – ван-дер-Хейде (Ш-вд-Х). Рентгенологически достоверным (р-д) считали двусторонний сакроилиит (СИ) II степени и выше или односторонний СИ III степени и выше по Kellgren. 15 пациентам без р-дСИ провели магнитно-резонансную томографию (МРТ) крестцово-подвздошных суставов (КПС). Рентгенологическими проявлениями псориатического спондилита считали синдесмофиты, паравертебральные оссификаты, сужение и анкилоз дугоотростчатых суставов ШОП. 45 пациентам было проведено типирование антигена HLA-B27.

Результаты и обсуждение

Результаты и обсуждение. ВБС выявлена у 34 (66,7%), хр-БС – у 17 (33,3%), поздний возраст (после 40 лет) начала ВБС/хр-БС – у 15 (28,8%), р-дСИ – у 30 (57,7%) больных; в 18 (34,6%) случаях СИ не выявлен. У 13 из 30 (43,3%) больных с р-дСИ ВБС отсутствовали. Эрозии обнаружены у 38 (76%), остеолиз – у 13 (26%), околосуставные костные пролиферации – у 18 (36%) пациентов. Средний счет Ш-вд-Х составил 82,79±64,77. Счет Ш-вд-Х коррелировал с наличием р-дСИ (r=0,46; p<0,05). Выявлена корреляция между р-дСИ и ограничением подвижности позвоночника по BASMI (Bath Ankylosing Spondylitis Metrology Index) (r=0,35). При наличии околосуставной костной пролиферации р-дСИ выявлялся статистически значимо чаще, чем при ее отсутствии (р=0,02). У больных ПсА, имеющих остеолиз суставов, поражение позвоночника в виде асимметричных синдесмофитов отмечалось в 10 раз чаще (ОШ=10; 95% ДИ: 1,63–61,327). Синдесмофиты в ШОП формировались в 2 раза чаще, чем в ПОП (р=0,01). Изолированное поражение ШОП при отсутствии изменений в ПОП наблюдалось в 30% случаев. СИ при МРТ выявлен у 2 (13,3%) больных. У 9 (18,0%) пациентов поражение позвоночника носило изолированный характер и не сопровождалось СИ. 15 (33,3%) больных были позитивны по HLA-B27. Выявлены определенные особенности поражения осевого скелета при ПсА: возможность малосимптомного течения, поздний возраст дебюта болей в спине, ассоциация с тяжелым деструктивным периферическим артритом, более выраженное поражение ШОП по сравнению с ПОП. Выделена группа больных (18%) с альтернативным фенотипом – без СИ по данным рентгенографии и МРТ, но с поражением позвоночника. Ключевые слова: псориатический артрит, аксиальное поражение>˂ 0,05). Выявлена корреляция между р-дСИ и ограничением подвижности позвоночника по BASMI (Bath Ankylosing Spondylitis Metrology Index) (r=0,35). При наличии околосуставной костной пролиферации р-дСИ выявлялся статистически значимо чаще, чем при ее отсутствии (р=0,02). У больных ПсА, имеющих остеолиз суставов, поражение позвоночника в виде асимметричных синдесмофитов отмечалось в 10 раз чаще (ОШ=10; 95% ДИ: 1,63–61,327). Синдесмофиты в ШОП формировались в 2 раза чаще, чем в ПОП (р=0,01). Изолированное поражение ШОП при отсутствии изменений в ПОП наблюдалось в 30% случаев. СИ при МРТ выявлен у 2 (13,3%) больных. У 9 (18,0%) пациентов поражение позвоночника носило изолированный характер и не сопровождалось СИ. 15 (33,3%) больных были позитивны по HLA-B27. Выявлены определенные особенности поражения осевого скелета при ПсА: возможность малосимптомного течения, поздний возраст дебюта болей в спине, ассоциация с тяжелым деструктивным периферическим артритом, более выраженное поражение ШОП по сравнению с ПОП. Выделена группа больных (18%) с альтернативным фенотипом – без СИ по данным рентгенографии и МРТ, но с поражением позвоночника. 

Objective

Objective: to evaluate clinical and instrumental characteristics of axial lesion in psoriatic arthritis (PsA) in real-life clinical practice.

Subjects and methods

Subjects and methods. Examination were made in 52 patients (32 men and 20 women) with back pain recorded either at the time of their admission or in their medical histories. The inflammatory back pain (IBP) was diagnosed according to the Assessment of SpondyloArthritis international Society (ASAS) criteria. Back pain lasting over three months without meeting the ASAS criteria was taken to be chronic back (chrBP). Hands, feet, pelvis, cervical spine (CSP) and lumbar spine (LSP) were X-rayed. Erosions, osteolysis, and periarticular osteo-proliferative lesions were evaluated applying PsA-modified Sharp/van der Heijde score (SHS). Sacroiliitis (SI) was considered radiologically significant (r-sSI) when it was bilateral grade II or higher, or unilateral grade III or higher by Kellgren. 15 patients without r-sSI had their sacroiliac joints (SIJs) scanned using magnetic resonance imaging (MRI). Syndesmophytes, paravertebral ossifications, constriction and ankylosis of the CSP zygapophysial joints were considered to be radiological signs of psoriatic spondylitis. HLA-B27 typing was performed in 45 patients.

Results and discussion

Results and discussion. IBP was identified in 34 (66.7%), chrBP in 17 (33.3%) patients; 15 patients (28.8%) were of advanced age (over 40) at the onset of IBP/chrBP; 30 cases (57.7%) had r-sSI; in 18 cases SI was not detected. 13 out of 30 r-sSI patients (43.3%) didn’t suffer IBP. Erosions were detected in 38 (76%) patients, osteolysis in 13 (26%) and osteo-proliferative lesions in 18 (36%) patients. Average SHS was 82.79±64.77 correlating with the presence of r-sSI (r=0,46; p<0,05). Correlation of r=0.35 was found between r-sSI and the spine limited mobility according to Bath Ankylosing Spondylitis Metrology Index (BASMI); r-sSI was detected with much higher statistical significance in the presence of periarticular osteo-proliferative lesions than in the absence of such (р=0.02). In PsA patients having periarticular osteolysis, axial lesion in the form of asymmetric syndesmophytes was detected ten times more frequently than in those not having it (OR=10; 95% CI: 1.63–61.327). In CSP, syndesmophytes developed two times more frequently than in LSP (p=0.01). Discrete CSP lesions in the absence of any LSP changes was observed in 30% of cases. SI was MRI detected in 2 (13.3%) patients. In 9 (18.0%) patients axial lesions were observed without SI. 15 patients (33.3%) were HLA-B27 positive. A set of specific PsA axial skeletal involvement features were revealed: possibility of oligosymptomatic clinical presentation; patient’s advanced age at the back pain onset; association with severe destructive peripheral arthritis; and more pronounced CSP lesions as compared to LSP. An alternative phenotype patient group (18%) without X-ray or MRI SI but with spine involvement was identified. Key words: psoriatic arthritis; axial lesion>˂ 0,05). Correlation of r=0.35 was found between r-sSI and the spine limited mobility according to Bath Ankylosing Spondylitis Metrology Index (BASMI); r-sSI was detected with much higher statistical significance in the presence of periarticular osteo-proliferative lesions than in the absence of such (р=0.02). In PsA patients having periarticular osteolysis, axial lesion in the form of asymmetric syndesmophytes was detected ten times more frequently than in those not having it (OR=10; 95% CI: 1.63–61.327). In CSP, syndesmophytes developed two times more frequently than in LSP (p=0.01). Discrete CSP lesions in the absence of any LSP changes was observed in 30% of cases. SI was MRI detected in 2 (13.3%) patients. In 9 (18.0%) patients axial lesions were observed without SI. 15 patients (33.3%) were HLA-B27 positive. A set of specific PsA axial skeletal involvement features were revealed: possibility of oligosymptomatic clinical presentation; patient’s advanced age at the back pain onset; association with severe destructive peripheral arthritis; and more pronounced CSP lesions as compared to LSP. An alternative phenotype patient group (18%) without X-ray or MRI SI but with spine involvement was identified. 

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