rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2023-493-500rsp-3404Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHОценка возможности применения критериев аксиального спондилоартрита и анкилозирующего спондилита для диагностики поражения позвоночника при псориатическом артритеEvaluation of the possibility of axial psoriatic arthritis patients meet classification criteria for axial spondyloarthritis and ankylosing spondylitishttps://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.KorsakovaY. 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

УрумоваМ. 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 Federation202331082023614493500Copyright © Губарь Е.Е., Коротаева Т.В., Корсакова Ю.Л., Логинова Е.Ю., Смирнов А.В., Сухинина А.В., Урумова М.М., Глухова С.И., 20232023Губарь 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/3404

Цель – проанализировать возможность применения критериев аксиального спондилоартрита (аксСпА) и анкилозирующего спондилита (АС) для диагностики поражения позвоночника при псориатическом артрите (ПсА).Материал и методы. Обследовано 104 больных ПсА (66 мужчин и 38 женщин) с диагнозом ПсА, соответству ющим критериям CASPAR, с наличием боли в позвоночнике. Оценивали воспалительную боль в спине (ВБС) по критериям ASAS и хроническую боль в спине (хр-БС), не соответствовавшую критериям ВБС. Выполняли рентгенографию кистей, стоп, таза, шейного и поясничного отделов позвоночника. Оценивали эрозии, остеолиз, внесуставные остеопролиферации. Рентгенологически достоверным сакроилиитом (р-дСИ) считали двусторонний СИ ≥II ст. или односторонний ≥III ст. 19 пациентам без р-дСИ провели магнитно-резонансную томографию (МРТ) крестцово-подвздошных суставов (КПС). 93 пациентам проведено типирование антигена HLA-B27. Определяли число пациентов, соответствовавших критериям аксСпА (ASAS) и модифицированным Нью-Йоркским (мНЙ) критериям АС.Результаты. ВБС выявлена у 67 (64,4%), хр-БС – у 37 (35,6%) пациентов. Поздний возраст начала ВБС/хр-БС (после 40 лет) выявлен у 31 (29,8%) пациента. Р-дСИ обнаружен у 57 (58,8%), активный СИ при МРТ выявили у 6 (31,6%), синдесмофиты обнаружены у 57 (58,8%) больных. Среди 40 больных без р-дСИ у 19 (47,5%) обнаружены синдесмофиты. Признаки как р-дСИ, так и спондилита выявлены у 38 (39,2%), изолированный р-дСИ без спондилита – у 19 (19,6%), изолированный спондилит без р-дСИ – у 19 (19,6%) из 97 больных. HLA-B27 обнаружен у 28 (30,1%). Критериям аксСпА соответствовал 51 (55,4%) пациент. Среди 41 (44,6%) больного, не соответствовавшего критериям аксСпА, у 27 (65,9%) имелись синдесмофиты. 48 (48,5%) больных ПсА соответствовали мНЙ критериям АС. Среди них у 18 (37,5%) ВБС отсутствовала, у 18 (37,5%) – дебют ВБС/хр-БС после 40 лет, у 34 (70,8%) – дактилит, у 38 (79,2%) – эрозивный полиартрит, у 23 (48,8%) – внесуставные костные пролиферации, у 14 (30,2%) – остеолиз, у 23 (48,9%) – объемные, не смыкающиеся синдесмофиты, у 40 (82,6%) – псориаз ногтей, у 28 (66,6%) отсутствовал антиген HLA-B27.Заключение. 45% больных аксПсА не соответствуют критериям аксСпА. Выявлены характерные особенности, позволяющие дифференцировать аксПсА от АС в случае соответствия критериям двух диагнозов.

Objective – to analyze whether axial psoriatic arthritis (axPsA) patients meet classification criteria for axial spondyloarthritis (axSpA) and ankylosing spondylitis (AS).Subjects and methods. 104 patients (66 men and 38 women) with PsA according to CASPAR criteria were examined, all patients had back pain. Patients were evaluated for presence of inflammatory back pain (IBP) by ASAS criteria. Back pain not meeting the ASAS criteria was taken to be chronic back (chrBP). Patients underwent hands, feet and pelvis, cervical spine and lumbar spine X-rays. Erosions, osteolysis, and periarticular osteo-proliferative lesions were evaluated. Radiographically significant sacroiliitis (r-sSI) was defined as bilateral grade ≥2 or unilateral grade ≥3. 19 patients without r-sSI underwent sacroiliac joints MRI. 93 patients underwent HLA B27 examination. The number of patients who met the criteria for axSpA (ASAS) and the modified New York (mNY) criteria for AS was determined.Results. IBP was identified in 67 (64.4%), chrBP in 37 (35.6%) patients; 31 (29.8%) patients were of advanced age (over 40) at the onset of IBP/chrBP; 57 (58.8%) cases had r-sSI; 6 (31.6%) patients had MRI-SI; syndesmophytes were detected in 57 (58.8%) cases. Among 40 patients without r-sSI, 19 (47.5%) had syndesmophytes. In 38 (39.2%) out of 97 patients r-sSI was detected along with syndesmophytes, while 19 (19.6%) out of 97 patients had isolated r-sSI without spondylitis, and 19 (19.6%) out of 97 patients had isolated syndesmophytes without r-sSI. HLA B27 was present in 28 (30.1%) cases. 51 (55.4%) patients met criteria for axSpA. 41 (44.6%) patients didn’t meet criteria for axSpA, however 27 (65.9%) of them had syndesmophytes. 48 (48.5%) PsA patients met mNY criteria for AS.Among these patients a set of specific features was revealed: 18 (37.5%) had no IBP, 18 (37.5%) were of advanced age (over 40) at the onset of IBP/ chrBP, 34 (70.8%) had dactylitis, 38 (79.2%) – erosive polyarthritis, 23 (48.8%) – periarticular osteo-proliferative lesions, 14 (30.2%) – osteolysis, 23 (48,9%) – “chunky” non-marginal syndesmophytes, 40 (82,6%) – nail psoriasis, 28 (66,6%) patients were HLA-B27 negative.Conclusion. 45% of axPsA patients don’t meet criteria for axSpA. Characteristic features have been identified to differentiate axPsA from AS.

ксиальный псориатический артриткритерии аксиального спондилоартритаанкилозирующий спондилитaxial psoriatic arthritisaxial arthritis criteriaankylosing spondylitisИсследование проводилось в рамках выполнения научной темы № 1021051503111-9 «Совершенствование диагностики и фармакотерапии спондилоартритов на основании сравнительных результатов изучения прогностических (в том числе молекулярно-биологических, молекулярно-генетических, клинико-визуализационных) факторов прогрессирования заболевания и уровня качества жизни больных», утвержденной Ученым советом ФГБНУ НИИР им. В.А. Насоновой.ReferencesChandran V. Psoriatic spondylitis or ankylosing spondylitis with psoriasis: Same or different? Curr Opin Rheumatol. 2019;31: 329-334. doi: 10.1097/BOR.0000000000000609Chandran V. Psoriatic spondylitis or ankylosing spondylitis with psoriasis: Same or different? 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The authors declare that there are no conflicts of interest present.