rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2023-735-743rsp-3473Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHКлинические проявления и прогноз гигантоклеточного артериита: ретроспективное когортное исследованиеClinical manifestations and prognosis of giant cell arteritis: A retrospective cohort studyhttps://orcid.org/0000-0003-0853-8967ФилатоваЕ. Е.FilatovaE. E.

Филатова Екатерина Евгеньевна.

119435, Москва, ул. Россолимо, 11/5

Ekaterina E. Filatova.

119435, Moscow, Rossolimo str., 11/5

filatevichk@gmail.comhttps://orcid.org/0000-0002-3989-2590БулановН. М.BulanovN. M.

Буланов Николай М.

119435, Москва, ул. Россолимо, 11/5

Nikolay M. Bulanov.

119435, Moscow, Rossolimo str., 11/5

https://orcid.org/0000-0002-5187-0108МешковА. Д.MeshkovA. D.

129226, Москва, ул. 1-я Леонова, 16

Alexey D. Meshkov.

129226, Moscow, 1-ya Leonova str., 16

https://orcid.org/0000-0002-6866-188XБородинО. О.BorodinO. O.

119435, Москва, ул. Россолимо, 11/5

Oleg O. Borodin.

119435, Moscow, Rossolimo str., 11/5

https://orcid.org/0000-0002-1508-3975СмитиенкоИ. О.SmitienkoI. O.

119415, Москва, ул. Лобачевского, 42, стр. 4

Ilya O. Smitienko.

119415, Moscow, Lobachevskogo str., 42, building 4

https://orcid.org/0000-0003-4268-2655ЧачилоЕ. В.ChachiloE. V.

119435, Москва, ул. Россолимо, 11/5

Elizaveta V. Chachilo.

119435, Moscow, Rossolimo str., 11/5

https://orcid.org/0000-0003-1561-6353НартовА. А.NartovA. A.

119435, Москва, ул. Россолимо, 11/5

Andrei A. Nartov.

119435, Moscow, Rossolimo str., 11/5

https://orcid.org/0000-0002-1530-3464ФилатоваА. Л.FilatovaA. L.

119435, Москва, ул. Россолимо, 11/5; 119234, Москва, ул. Ленинские горы, 1

Anna L. Filatova.

119435, Moscow, Rossolimo str., 11/5; 119234, Moscow, Leninskie Gory, 1

https://orcid.org/0000-0002-6253-621XНаумовА. В.NaumovA. V.

129226, Москва, ул. 1-я Леонова, 16

Anton V. Naumov.

129226, Moscow, 1-ya Leonova str., 16

https://orcid.org/0000-0003-0148-5655НовиковП. И.NovikovP. I.

119435, Москва, ул. Россолимо, 11/5

Pavel I. Novikov.

119435, Moscow, Rossolimo str., 11/5

https://orcid.org/0000-0002-7232-4640МоисеевС. В.MoiseevS. V.

Моисеев Сергей В.

119435, Москва, ул. Россолимо, 11/5; 119234, Москва, ул. Ленинские горы, 1

Sergey V. Moiseev.

119435, Moscow, Rossolimo str., 11/5; 119234, Moscow, Leninskie Gory, 1

Клиника ревматологии, нефрологии и профпатологии им. Е.М. Тареева, ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияTareev Clinic of Rheumatology, Nephrology and Occupational Pathology, I.M. Sechenov First Moscow State Medical University of the Ministry of Health Care of Russian Federation (Sechenov University)Russian FederationРоссийский геронтологический научно-клинический центр, ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииРоссияRussian Gerontological Research and Clinical Center, N.I. Pirogov Russian National Research Medical UniversityRussian FederationНОЧУ «Международный институт постдипломного медицинского образования»РоссияInternational Institute of Postgraduate Medical EducationRussian FederationКлиника ревматологии, нефрологии и профпатологии им. Е.М. Тареева, ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет); ФГБОУ ВО «Московский государственный университет им. М.В. Ломоносова»РоссияTareev Clinic of Rheumatology, Nephrology and Occupational Pathology, I.M. Sechenov First Moscow State Medical University of the Ministry of Health Care of Russian Federation (Sechenov University); Lomonosov Moscow State UniversityRussian Federation202331122023616735743Copyright © Филатова Е.Е., Буланов Н.М., Мешков А.Д., Бородин О.О., Смитиенко И.О., Чачило Е.В., Нартов А.А., Филатова А.Л., Наумов А.В., Новиков П.И., Моисеев С.В., 20242024Филатова Е.Е., Буланов Н.М., Мешков А.Д., Бородин О.О., Смитиенко И.О., Чачило Е.В., Нартов А.А., Филатова А.Л., Наумов А.В., Новиков П.И., Моисеев С.В.Filatova E.E., Bulanov N.M., Meshkov A.D., Borodin O.O., Smitienko I.O., Chachilo E.V., Nartov A.A., Filatova A.L., Naumov A.V., Novikov P.I., Moiseev S.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/3473

Цель исследования – оценить клинические проявления и выживаемость пациентов c гигантоклеточным артериитом (ГКА).

Методы

Методы. В ретроспективное исследование были включены 166 пациентов с впервые диагностированным ГКА. Для подтверждения диагноза использовали клинико-лабораторные и инструментальные данные, три набора классификационных критериев: критерии Американской коллегии ревматологов (ACR, American College of Rheumatology) 1990 г., пересмотренные критерии ACR от 2016 г. и/или новые критерии ACR и Европейского альянса ревматологических ассоциаций (EULAR, European Alliance of Associations for Rheumatology) 2022 г. Части пациентов были выполнены инструментальные исследования: ультразвуковая допплерография височной артерии (n=61); компьютерная томография (КТ) с контрастным усилением (n=5); КТ-ангиография (n=6); магнитно-резонансная томография (n=4); магнитно-резонансная ангиография (n=3); позитронно-эмиссионная томография/КТ с 18F-фтордезоксиглюкозой (n=47). Общую и безрецидивную выживаемость анализировали с помощью таблиц дожития, метода Каплана – Мейера.

Результаты

Результаты. Первыми проявлениями ГКА чаще всего были головная боль (81,8%), слабость (64%), лихорадка (63,8%) и симптомы ревматической полимиалгии (56,6%). Изменения височных артерий при цветовом дуплексном сканировании выявили у 44 из 61 больного. Терапия глюкокортикоидами (ГК) проводилась всем пациентам, согласившимся получать лечение (n=158), метотрексат назначен 49 из 158 пациентов, лефлуномид – 9 пациентам. У 45 (28,5%) из 158 больных была достигнута стойкая ремиссия в результате монотерапии ГК, 120 (75,9%) для профилактики обострений потребовалась длительная поддерживающая терапия ГК, в том числе 71 (44,9%) – в сочетании с метотрексатом или другими иммуносупрессивными препаратами. Медиана периода наблюдения пациентов с обострениями в анамнезе составила 21,0 [8,0; 54,0] месяц. Обострения развились у 73 (46,2%) пациентов. Общая однолетняя выживаемость составила 97,1% [95%-й доверительный интервал (95% ДИ): 94,3; 99,9], пятилетняя – 94,6% [95% ДИ: 90,2; 99,0]; безрецидивная однолетняя выживаемость – 86,4% [95% ДИ: 80,5; 92,3], пятилетняя – 52,4% [95% ДИ: 42,0; 62,8]. Всего умерли 12 (7,2%) из 166 пациентов. Причиной смерти явились инфаркт миокарда (n=2), инсульт (n=2) и рак молочной железы (n=1), в остальных 7 случаях причина смерти не установлена.

Заключение

Заключение. Учитывая высокую частоту обострений заболевания, пациенты с ГКА требуют длительного наблюдения, в особенности в течение первого года после установления диагноза.

The aim of the study was to evaluate the clinical manifestations and survival of patients with giant cell arteritis (GCA).

Methods

Methods. A retrospective study included 166 patients with newly diagnosed GCA. Clinical, laboratory and instrumental data, three sets of classification criteria were used to confirm the diagnosis: the American College of Rheumatology (ACR) 1990, the revised ACR criteria of 2016 and/or the new ACR and European Alliance of Associations for Rheumatology (EULAR) 2022 criteria. Some of the patients underwent instrumental investigations: temporal artery ultrasound Doppler (n=61), contrast-enhanced computed tomography (CT) (n=5), CT angiography (n=6), magnetic resonance imaging (n=4), magnetic resonance angiography (n=3) and 18F-FDG positron emission tomography/CT (n=47). Overall and recurrence-free survival were analyzed using survival tables, Kaplan – Meier method.

Results

Results. The most frequent first manifestations of GCA were headache (81.8%), weakness (64%), fever (63.8%) and symptoms of rheumatic polymyalgia (56.6%). Changes of temporal arteries in color duplex scanning were detected in 44 out of 61 patients. GCs therapy was performed in all patients who agreed to be treated (n=158), methotrexate was used in 49 out of 158 patients, leflunomide – in 9 patients. In 45 (28.5%) out of 158 patients a stable remission was achieved as a result of GCs monotherapy, in 120 (75.9%) patients long-term maintenance therapy with GCs was required to prevent exacerbations, including 71 (44.9%) patients – in combination with methotrexate or other immunosuppressive drugs. The follow-up period of patients with a history of relapses was 21.0 (8.0–54.0) months. Relapses developed in 73 (46.2%) patients. The overall one-year survival rate was 97.1% [95% confidence interval (CI): 94.3; 99.9], and the five-year survival rate of patients was 94.6% [95% CI: 90.2; 99.0]. The one-year relapse-free survival rate was 86.4% [95% CI: 80.5; 92.3], and the five-year relapse-free survival rate was 52.4% [95% CI: 42.0; 62.8]. 12 (7.2%) of 166 patients died. The cause of death was myocardial infarction in two patients, stroke in two patients, and breast cancer in one patient; in the remaining seven cases, the cause of death was not determined.

Conclusion

Conclusion. Given the high frequency of disease exacerbation, patients with GCA require long-term follow-up, especially during the first year after diagnosis.

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