rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2024-168-175rsp-3546Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHСравнительная характеристика аксиального спондилоартрита и псориатического артрита с поражением позвоночникаComparative characteristics of axial spondyloarthritis and psoriatic arthritis with axial involvementhttps://orcid.org/0000-0001-5015-7143ГубарьЕ. Е.GubarЕ. Е.

Губарь Елена Ефимовна

115522, Москва, Каширское шоссе, 34а

Elena E. Gubar

115522, Moscow, Kashirskoye Highway, 34A

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

115522, Москва, Каширское шоссе, 34а

Tatiana V. Korotaeva

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-1771-6246ДубининаТ. В.DubininaТ. V.

115522, Москва, Каширское шоссе, 34а

Tatiana V. Dubinina

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0001-8626-8419ВоробьеваЛ. Д.VorobyevaL. D.

115522, Москва, Каширское шоссе, 34а

Lyubov D. Vorobyeva

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0003-4005-1745ТремаскинаП. О.TremaskinaР. О.

115522, Москва, Каширское шоссе, 34а

Polina O. Tremaskina

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-2246-686XАгафоноваЕ. М.AgafonovaЕ. М.

115522, Москва, Каширское шоссе, 34а

Ekaterina M. Agafonova

115522, Moscow, Kashirskoye Highway, 34A

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

115522, Москва, Каширское шоссе, 34а

Yulia L. Korsakova

115522, Moscow, Kashirskoye Highway, 34A

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

115522, Москва, Каширское шоссе, 34а

Elena Yu. Loginova

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0003-2486-8798СахароваК. В.SakharovaК. V.

115522, Москва, Каширское шоссе, 34а

Ksenia V. Sakharova

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-0337-453XСаблинаА. О.SablinaА. О.

115522, Москва, Каширское шоссе, 34а

Anastasiya O. Sablina

115522, Moscow, Kashirskoye Highway, 34A

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

115522, Москва, Каширское шоссе, 34а

Alexander V. Smirnov

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0003-3195-5187ЭрдесШ. Ф.ErdesS. F.

115522, Москва, Каширское шоссе, 34а

Shandor F. Erdes

115522, Moscow, Kashirskoye Highway, 34A

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

115522, Москва, Каширское шоссе, 34а

Margarita M. Urumova

115522, Moscow, Kashirskoye Highway, 34A

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

115522, Москва, Каширское шоссе, 34а

Svetlana I. Glukhova

115522, Moscow, Kashirskoye Highway, 34A

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation202428042024622168175Copyright © Губарь Е.Е., Коротаева Т.В., Дубинина Т.В., Воробьева Л.Д., Тремаскина П.О., Агафонова Е.М., Корсакова Ю.Л., Логинова Е.Ю., Сахарова К.В., Саблина А.О., Смирнов А.В., Эрдес Ш.Ф., Урумова М.М., Глухова С.И., 20242024Губарь Е.Е., Коротаева Т.В., Дубинина Т.В., Воробьева Л.Д., Тремаскина П.О., Агафонова Е.М., Корсакова Ю.Л., Логинова Е.Ю., Сахарова К.В., Саблина А.О., Смирнов А.В., Эрдес Ш.Ф., Урумова М.М., Глухова С.И.Gubar Е.Е., Korotaeva Т.V., Dubinina Т.V., Vorobyeva L.D., Tremaskina Р.О., Agafonova Е.М., Korsakova Y.L., Loginova Е.Y., Sakharova К.V., Sablina А.О., Smirnov А.V., Erdes S.F., Urumova М.М., Glukhova S.I.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/3546

Цель исследования – сравнить клинико-инструментальные характеристики больных аксиальным спондилоартритом (аксСпА)/анкилозирующим спондилитом (АС) и псориатическим артритом (ПсА) с поражением позвоночника – аксиальным псориатическим артритом (аксПсА).

Материал и методы

Материал и методы. Обследовано 100 больных: 45 – с аксСпА/АС (1-я группа); 55 – с аксПсА (2-я группа). В первую группу включены пациенты, соответствующие критериям аксСпА/критериям АС; во вторую – пациенты, соответствующие критериям CASPAR (ClASsification criteria for Psoriatic ARthritis). Аксиальное поражение устанавливали при наличии рентгенологически достоверного сакроилиита (СИ; двустороннего ≥II стадии или одностороннего ≥III стадии), или активного СИ по данным магнитно-резонансной томографии, или при наличии ≥1 синдесмофита в шейном (ШОП) и/или поясничном (ПОП) отделе позвоночника. Определяли воспалительную боль в спине (ВБС) по критериям ASAS (Assessment of Spondyloarthritis International Society).

Результаты и обсуждение

Результаты и обсуждение. Пациенты 1-й группы были моложе (р<0,001), у них чаще выявлялись HLA-B27 (р<0,001) и ВБС (р=0,001). Пациенты 2-й группы чаще имели поздний возраст (>40 лет) дебюта болей в спине (р<0,001), периферический артрит (р<0,001), дактилит (р=0,004), псориаз кожи (р<0,001). Псориаз ногтей выявлен только у больных 2-й группы (р<0,001). Пяточный энтезит чаще наблюдался в 1-й группе (р=0,005). У пациентов 2-й   отмечались более высокие значения BASDAI (Bath Ankylosing Spondylitis Disease Activity Index; p=0,006), ASDAS-СРБ (Ankylosing Spondylitis Disease Activity Score с определением уровня С-реактивного белка; р<0,001), BASFI (Bath Ankylosing Spondylitis Functional Index; p=0,004), оценки боли (p=0,005) и общей оценки заболевания пациентом (p=0,036). Во 2-й группе чаще выявлялись синдесмофиты в ПОП (р=0,009) и ШОП (р=0,007), эрозии суставов кистей и стоп (р=0,001), остеолиз (р=0,015), внесуставные костные пролиферации (р<0,001) и анкилоз суставов (р=0,02). Только во 2-й группе выявлены объемные «некраевые» синдесмофиты (32,1%), а также изменения позвоночника при отсутствии СИ (20%). Критериям аксСпА соответствовали все пациенты 1-й группы и только 80% больных 2-й группы (р=0,003). АксСпА/АС и аксПсА – это разные заболевания. В данной когорте аксПсА протекал тяжелее, чем аксСпА и АС.

Objective – to compare clinical characteristics of patients with axial spondyloarthritis (axSpA)/ankylosing spondylitis (AS) and with axial psoriatic arthritis (axPsA).

Subjects and methods

Subjects and methods. 100 patients were examined: 45 – with axSpA/AS (group 1), 55 – with axPsA (group 2). Patients of group 1 were included according to axSpA/AS criteria, patients of group 2 – according to CASPAR (ClASsification criteria for Psoriatic ARthritis) criteria, and having axial involvement (axPsA). Axial involvement was detected in case of radiologically significant sacroiliitis (bilateral grade ≥2 or unilateral grade ≥3) or active MRI sacroiliitis, or ≥1 syndesmophyte(s) of the cervical and/or lumbar spine. Patients were evaluated for presence of inflammatory back pain (IBP) by ASAS (Assessment of Spondyloarthritis International Society) criteria.

Results and discussion

Results and discussion. Patients of group 1 were younger (p<0.001), more often HLA-B27 positive (p<0.001), had more IBP (p=0.001). Patients of group 2 had older age (>40 years) at back pain onset (p<0.001), more often peripheral arthritis (p<0.001), dactylitis (p=0.004), and skin psoriasis (p<0.001). Nail psoriasis was found only in group 2 patients (p<0.001). Group 1 patients had more often heel enthesitis (p=0.005). Group 2 patients had worse axial disease activity scores: BASDAI (Bath Ankylosing Spondylitis Disease Activity Index; p=0.006) and ASDAS-СRP (Ankylosing Spondylitis Disease Activity Score with C-reactive protein level determination; р<0.001); and worse patient reported outcomes: BASFI (Bath Ankylosing Spondylitis Functional Index; p=0.004), patients’ pain (p=0.005) and patients’ global assessments (p=0.036). Patients of group 2 had more syndesmophytes of the lumbar (р=0.009) and cervical (р=0.007) spine. Only in group 2 patients, chunky “non-marginal” syndesmophytes were found (in 32.1%), as well as spinal lesions without sacroiliitis (in 20.0%). Patients of group 2 had more joint erosions (р=0.001), osteolysis (р=0.015), juxta-articular bone formation (р<0.001) and joint ankyloses (р=0.02). All patients of group 1 and only 80% of group 2 (р=0.003) met ASAS criteria for axSpA. AxSpA/AS and axPsA seem to be two different diseases. In our cohort of patients, axPsA patients had worse disease status compared to axSp and AS.

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