rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2012-707rsp-844Research ArticleСтатьиArticlesОценка активности заболевания у больных анкилозирующим спондилитом в реальной практике врача-ревматолога в России (часть 2)Estimation of disease activity in patients with ankylosing spondylitis in the real practice of a rheumatologist in Russia (Part 2)VolnukhinEvgeny VladimirovichVolnukhinEvgeny Vladimirovichdrzhe07@rambler.ruГалушкоЕ. А.GalushkoE A-БочковаА. Г.BochkovaA G-СмирновА. В.SmirnovA V-ЭрдесШ. Ф.ErdesSh F-201215062012503№3 (2012)3842Copyright © Volnukhin E.V., Галушко Е.А., Бочкова А.Г., Смирнов А.В., Эрдес Ш.Ф., 20122012Volnukhin E.V., Галушко Е.А., Бочкова А.Г., Смирнов А.В., Эрдес Ш.Ф.Volnukhin E.V., Galushko E.A., Bochkova A.G., Smirnov A.V., Erdes S.F.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/844

Цель - сравнить различные методы оценки активности анкилозирующего спондилита (АС) в реальной практике врача-ревматолога в Российской Федерации. Материал и методы. В исследование включено 464 больных АС, последовательно пришедших к ревматологам в течение 4 мес в 24 городах России. На всех пациентов заполнялась специально разработанная клиническая карта. У всех больных определялись индексы BASDAI, ASDAS, общая оценка активности заболевания врачом, СОЭ и уровень С-реактивного белка (СРБ). У больных аксиальным АС определяли индекс mini-BASDAI. Диагноз болезни верифицировался в ФГБУ «НИИР» РАМН по модифицированным Нью-Йоркским критериям 1984 г., включая оценку рентгенограмм. Проводилось сравнение всех методов оценки активности. Результаты. Всего из включенных в исследование 464 больных достоверный диагноз АС был подтвержден у 330 (71,1%), аксиальный АС был у 178 из них; средний возраст составил 39,7+10,2 года, средняя длительность заболевания -14,6+2,6 года, мужчин было 86%, женщин - 14%. Около 61% больных имели высокую активность по индексу BASDAI, 74% - по индексу mini-BASDAI (n=178), 88% больных имели высокую и очень высокую активность заболевания по индексу ASDAS (СОЭ); среднее значение СОЭ по Вестергрену составило 33,8+29 мм/ч, а СРБ (n=249) - 30 мг/л. Выводы. При определении активности заболевания ревматологи в реальной клинической практике ориентируются в первую очередь на общую оценку активности и изменения острофазовых показателей крови (СОЭ и СРБ). Количество больных с высокой активностью заболевания, рассчитанное по индексам BASDAI и ASDAS, оказывается выше. В свою очередь ASDAS чаще выявляет высокую активность АС, чем BASDAI.

Objective: to compare different methods for estimating ankylosing spondylitis (AS) activity in the real practice of a rheumatologist in the Russian Federation. Subjects and methods. The investigation enrolled 464 patients with AS, who had consecutively visited rheumatologists for 4 months in 24 cities and towns of Russia. A specially designed clinical card was filled out for all patients. BASDAI and ASDAS scores were estimated by a physician and erythrocyte sedimentation rate (ESD) and C-reactive protein (CRP) were measured in all the patients. Mini-BASDAI scores were determined in patients with axial AS. The diagnosis of the disease was verified at the Research Institute of Rheumatology, Russian Academy of Medical Sciences, according to the 1984 modified New York criteria, by including X-ray film estimation. All activity assessment methods were compared. Results. The valid diagnosis of AS was confirmed in 330 (71.1%) out of all 464 patients included into the study; axial AS was present in 178 of them; their mean age was 39.7+10.2 years; the mean duration of disease was 14.6+2.6 years; 86% were men and 14% were women. About 61 and 74% of the patients (n = 178) had high BASDAI and mini-BASDAI scores, respectively; 88% had high and very high ASDAI (ESR) scores; the mean ESR (Westergren method) was 33.8+29 mm/h and CRP (n = 249) was 30 mg/l. Conclusion. On assessing the activity of disease, rheumatologists are primarily oriented to total activity scores and blood acutephase indicators (ESR and CRP) in real clinical practice. Patients with high disease activity calculated from BASDAI and ASDAS scores proved to be more. In its turn, ASDAS more frequently reveals high AS activity than BASDAI.

анкилозирующий спондилитактивность заболеванияострофазовые показатели кровииндексы BASDAImini-BASDAIASDASankylosing spondylitisdisease activityblood acute-phase indicatorsBASDAImini-BASDAIand ASD scoresReferences<div><p>Ревматология: Национальное руководство. Под ред. Е.Л. Насонова, В.А. Насоновой. М.: ГЭОТАР-Медиа, 2008;720 с.</p><p>Волнухин Е.В., Галушко Е.А., Бочкова А.Г. и др. Клиническое многообразие анкилозирующего спондилита в реальной практике врача-ревматолога в России (часть 1). Науч-практич ревматол 2012;51(2):44-9.</p><p>Spoorenberg A., van der Heijde D., de Klerk E. et al. Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis. J Rheumatol 1999;26:980-4.</p><p>De Vries M.K., van Eijk I.C., van der Horst-Bruinsma I.E. et al. Erythrocyte sedimentation rate, C-reactive protein level, and serum amyloid A protein for patient selection and monitoring of anti-tumor necrosis factor treatment in ankylosing spondylitis. Arthr Rheum 2009;61(11):1484-90.</p><p>Garrett S., Jenkinson T., Kennedy L.G. et al. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 1994;21(12):2286-91.</p><p>Boers M., Brooks P., Strand C.V., Tugwell P. The OMERACT filter for outcome measures in rheumatology. J Rheumatol 1998;25:198-9.</p><p>Berthelot J.M., Tortellier L., Lavy-Bregeon D. et al. High intraindividual week-to-week variability in BASDAI and BASFI values: are several evaluations needed before starting or stopping TNF-antagonist therapy for spondyloarthropathies? Join Bone Spine 2008;75:167-71.</p><p>Heuft-Dorenbosch L., van Tubergen A., Spoorenberg A. et al. The influence of peripheral arthritis on disease activity in ankylosing spondylitis patients as measured with the Bath Ankylosing Spondylitis Disease Activity Index. Arthr Rheum 2004;51(2):154-9.</p><p>Lukas C., Landewe R., Sieper J. et al. Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis 2009;68(1):18-24.</p><p>Sieper J., Rudwaleit M., Baraliakos X. et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 2009;68:1-44.</p><p>Ревматология: Клинические рекомендации. Под ред. Е.Л. Насонова. 2-е изд., испр. и доп. М.: ГЭОТАР-Медиа, 2010.</p><p>Van der Heijde D., Lie E., Kvien T.K. et al. ASDAS, a highly discriminatory ASAS-endorsed disease activity score in patients with ankylosing spondylitis. Ann Rheum Dis 2009;68(12):1811-8.</p><p>Nas K., Yildirim K., Cevik R. et al. Discrimination ability of ASDAS estimating disease activity status in patients with ankylosing spondylitis. Int J Rheum Dis 2010;13(3):240-5.</p><p>Eder L., Chandran V., Shen H. et al. Is ASDAS better than BASDAI as a measure of disease activity in axial psoriatic arthritis? Ann Rheum Dis 2010;69(12):2160-4.</p><p>Machado P.M., Landewe R.B., van der Heijde D.M. Endorsement of definitions of disease activity states and improvement scores for the Ankylosing Spondylitis Disease Activity Score: results from OMERACT 10. J Rheumatol 2011;38(7):1502-6.</p><p>Spoorenberg A., van Tubergen A., Landewe R. et al. Measuring disease activity in ankylosing spondylitis: patient and physician have different perspectives. Rheumatology (Oxford) 2005;44:789-95.</p><p>Pedersen S.J., Sorensen I.J., Hermann K.G. et al. Responsiveness of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and clinical and MRI measures of disease activity in a 1-year follow-up study of patients with axial spondyloarthritis treated with tumour necrosis factor alpha inhibitors. Ann Rheum Dis 2010;69(6):1065-71.</p><p>Van der Heijde D., Braun J., Dougados M. et al. Clinical improvement with etanercept versus sulfasalazine treatment in patients with ankylosing spondylitis: comparative performance of various efficacy measurements (ASCEND). In: 2010 Annual scientific meeting of the American College of Rheumatology (ACR); abstract 1927.</p><p>Aydin S.Z., Can M., Atagunduz P., Direskeneli H. Active disease requiring TNF-alpha-antagonist therapy can be well discriminated with different ASDAS sets: a prospective, follow-up of disease activity assessment in ankylosing spondylitis. Clin Exp Rheumatol 2010;28(5):752-5.</p></div><br /><div><p>Ревматология: Национальное руководство. Под ред. Е.Л. Насонова, В.А. Насоновой. М.: ГЭОТАР-Медиа, 2008;720 с.</p><p>Волнухин Е.В., Галушко Е.А., Бочкова А.Г. и др. Клиническое многообразие анкилозирующего спондилита в реальной практике врача-ревматолога в России (часть 1). Науч-практич ревматол 2012;51(2):44-9.</p><p>Spoorenberg A., van der Heijde D., de Klerk E. et al. Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis. J Rheumatol 1999;26:980-4.</p><p>De Vries M.K., van Eijk I.C., van der Horst-Bruinsma I.E. et al. Erythrocyte sedimentation rate, C-reactive protein level, and serum amyloid A protein for patient selection and monitoring of anti-tumor necrosis factor treatment in ankylosing spondylitis. Arthr Rheum 2009;61(11):1484-90.</p><p>Garrett S., Jenkinson T., Kennedy L.G. et al. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 1994;21(12):2286-91.</p><p>Boers M., Brooks P., Strand C.V., Tugwell P. The OMERACT filter for outcome measures in rheumatology. J Rheumatol 1998;25:198-9.</p><p>Berthelot J.M., Tortellier L., Lavy-Bregeon D. et al. High intraindividual week-to-week variability in BASDAI and BASFI values: are several evaluations needed before starting or stopping TNF-antagonist therapy for spondyloarthropathies? Join Bone Spine 2008;75:167-71.</p><p>Heuft-Dorenbosch L., van Tubergen A., Spoorenberg A. et al. The influence of peripheral arthritis on disease activity in ankylosing spondylitis patients as measured with the Bath Ankylosing Spondylitis Disease Activity Index. Arthr Rheum 2004;51(2):154-9.</p><p>Lukas C., Landewe R., Sieper J. et al. Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis 2009;68(1):18-24.</p><p>Sieper J., Rudwaleit M., Baraliakos X. et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 2009;68:1-44.</p><p>Ревматология: Клинические рекомендации. Под ред. Е.Л. Насонова. 2-е изд., испр. и доп. М.: ГЭОТАР-Медиа, 2010.</p><p>Van der Heijde D., Lie E., Kvien T.K. et al. ASDAS, a highly discriminatory ASAS-endorsed disease activity score in patients with ankylosing spondylitis. Ann Rheum Dis 2009;68(12):1811-8.</p><p>Nas K., Yildirim K., Cevik R. et al. Discrimination ability of ASDAS estimating disease activity status in patients with ankylosing spondylitis. Int J Rheum Dis 2010;13(3):240-5.</p><p>Eder L., Chandran V., Shen H. et al. Is ASDAS better than BASDAI as a measure of disease activity in axial psoriatic arthritis? Ann Rheum Dis 2010;69(12):2160-4.</p><p>Machado P.M., Landewe R.B., van der Heijde D.M. Endorsement of definitions of disease activity states and improvement scores for the Ankylosing Spondylitis Disease Activity Score: results from OMERACT 10. J Rheumatol 2011;38(7):1502-6.</p><p>Spoorenberg A., van Tubergen A., Landewe R. et al. Measuring disease activity in ankylosing spondylitis: patient and physician have different perspectives. Rheumatology (Oxford) 2005;44:789-95.</p><p>Pedersen S.J., Sorensen I.J., Hermann K.G. et al. Responsiveness of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and clinical and MRI measures of disease activity in a 1-year follow-up study of patients with axial spondyloarthritis treated with tumour necrosis factor alpha inhibitors. Ann Rheum Dis 2010;69(6):1065-71.</p><p>Van der Heijde D., Braun J., Dougados M. et al. Clinical improvement with etanercept versus sulfasalazine treatment in patients with ankylosing spondylitis: comparative performance of various efficacy measurements (ASCEND). In: 2010 Annual scientific meeting of the American College of Rheumatology (ACR); abstract 1927.</p><p>Aydin S.Z., Can M., Atagunduz P., Direskeneli H. Active disease requiring TNF-alpha-antagonist therapy can be well discriminated with different ASDAS sets: a prospective, follow-up of disease activity assessment in ankylosing spondylitis. Clin Exp Rheumatol 2010;28(5):752-5.</p></div><br />

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