rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2011-863rsp-996Research ArticleСтатьиArticlesОсобенности диагностики ревматоидного артрита в реальной клинической практикеThe specific features of diagnosis of rheumatoid arthritis in real clinical practiceГалушкоЕ. А.GalushkoElena Andreevnaorgcom@irramn.ru <mailto:orgcom@irramn.ru>ЭрдесШ. Ф.ErdesSh F-AmirdzhanovaV NAmirdzhanovaV N-ГалушкоЕ. А.GalushkoElena Andreyevnaorgcom@irramn.ru <mailto:orgcom@irramn.ru>ЭрдесШ. Ф.ErdesSh F-AmirdzhanovaV NAmirdzhanovaV N-201115022011491№1 (2011)2126Copyright © Галушко Е.А., Эрдес Ш.Ф., Amirdzhanova V.N., Галушко Е.А., Эрдес Ш.Ф., Amirdzhanova V.N., 20112011Галушко Е.А., Эрдес Ш.Ф., Amirdzhanova V.N., Галушко Е.А., Эрдес Ш.Ф., Amirdzhanova V.N.Galushko E.A., Erdes S.F., Amirdzhanova V.N., Galushko E.A., Erdes S.F., Amirdzhanova V.N.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/996

Цель. Изучение особенностей диагностики ревматоидного артрита (РА) в реальной практике. Материал и методы. Включено 1810 больных РА (из них 1520 женщин), средний возраст 54 года. Длительность заболевания составила в среднем 7 лет. Преобладали развернутая и поздняя клинические стадии РА (в целом - 86%), у 64,6% больных отмечалась высокая воспалительная активность заболевания (DAS 28>5,1). Результаты. Средний период между появлением первых симптомов РА и установлением данного диагноза составил 24 [8; 44] мес. Было показано, что лишь у 18% больных диагноз РА был установлен в первые 6 мес от начала заболевания. Однако данный показатель возрастал до 68%, если пациент сразу обращался к ревматологу, минуя других врачей. Каждый восьмой больной РА (13%) в возрасте 55 лет через 13 лет от начала болезни нуждается в эндопротезировании суставов. Эти пациенты имели более высокую активность воспалительного процесса (DAS 28=6,0) на момент исследования, средняя доза метотрексата у них не превышала 10 мг/нед, а период от начала заболевания до постановки диагноза был достоверно дольше, чем в общей выборке больных РА, и составил в среднем 31 мес. Заключение. Недостаточный уровень подготовки врачей по проблемам ревматологии увеличивает период от начала заболевания до постановки диагноза на амбулаторном этапе, приводя к развитию ранней инвалидности и необходимости эндопротезирования крупных суставов у больных РА.

Objective. To study the specific features of rheumatoid arthritis (RA) in real practice. Subjects and methods. The study included 1810 patients with RA (including 1520 women) whose mean age was 54 years. The history of the disease averaged 7 years. The extensive and late clinical stages of RA were predominant (86% as a whole); 64.6% of the patients were found to have a high inflammatory disease activity (DAS 28 >5.1). Results. The mean interval between the emergence of the first symptoms of RA and the moment of this diagnosis was 24 [8; 44] months. The diagnosis of RA was shown to be established in only 18% of the patients in the first 6 months of the disease onset. However, this indicator increased up to 68% if the patient immediately visited a rheumatologist, by disregarding medical advice from other physicians. Every eight (13%) RA patients aged 55 years require endoprosthetic joint replacement 13 years after the disease onset. These patients had a higher inflammatory process activity (DAS 28 = 6.0) at the moment of the study; their mean methotrexate dose was not greater than 10 mg/week and the interval between the disease onset and the moment of diagnosis was significantly longer that that in the general sample of patients with RA and averaged 31 months. Conclusion. Inadequate training of physicians in rheumatology problems increases the interval between the disease onset and the moment of outpatient diagnosis results in early disability and makes it necessary to make endoprosthetic replacement of large joints in patients with RA.

ревматоидный артритдиагностикаэндопротезирование суставовrheumatoid arthritisdiagnosisendoprosthetic joint replacementReferences<div><p>Насонов Е.Л. Фармакотерапия ревматоидного артрита в эру генно-инженерных биологических препаратов. Тер. арх. 2007; 5: 5-8.</p><p>Emery P., Breedveld F.C., Dougados M. et al. Early referral recommendation for newly diagnosed rheumatoid arthritis: evidence based development of a clinical guide. Ann Rheum Dis 2002; 61: 290-7.</p><p>Bruynesteyn K., Landewe R., van der Linden S., van der Heijde D. Radiography as primary outcome in rheumatoid arthritis: acceptable sample size for trials with 3 months follow-up. Ann Rheum Dis 2004; 63: 1413-8.</p><p>Van der Horst-Bruinsma I.E., Speyer I., Visser H. et al. Diagnosis and course of early onset arthritis: results of a special early arthritis clinic compared to routine patient care. Br J Rheumatol 1998; 37: 1084-8.</p><p>Чичасова Н.В., Владимиров С.А., Имаметдинова Г.Р. и др. Функциональные исходы ревматоидного артрита при различных способах противовоспалительной терапии. Науч.-практич. ревматол. 2010; 2: 30-6.</p><p>Каратеев Д. Е., Лучихина Е. Л., Тюрина Л. Н. и др. Возможности ранней диагностики ревматоидного артрита в клинической практике на современном этапе (результаты наблюдений за московской когортой больных ранним артритом в рамках программы РАДИКАЛ). Тер. арх. 2008; 80(5): 8-13.</p><p>Lineker S.C., Bell M.J., Boyle J. et al. Implementing arthritis clinical practice guidelines in primary care. Med Teach 2009; 31: 230-7.</p><p>Kumar K., Daley E., Carruthers D. et al. Delay in presentation to primary care physicians is the main reason why patients with rheumatoid arthritis are seen late by rheumatologists. Rheumatology (Oxford) 2007; 46(9): 1438-40.</p><p>Boyle E., Badley E.M., Glazier R.H. The relationship between local availability and first-time use of specialists in an arthritis population. Can J Public Health 2006; 97(3): 210-3.</p><p>Feldman D., Bernatsky S., Haggerty J. et al. Delay in consultation with specialists for persons with suspected new-onset rheumatoid arthritis: a population-based study. Arthr Rheum 2007; 57(8): 1419-25.</p><p>Arnett F.C., Edworthy S.M., Bloch D.A. et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthr Rheum 1988; 31: 315-24.</p><p>Sokka T., Mäkinen H., Hannonen P., Pincus T. Most people over age 50 in the general population do not meet ACR remission criteria or OMERACT minimal disease activity criteria for rheumatoid arthritis. Rheumatology (Oxford) 2007; 46(6): 1020-3.</p><p>MacKay C., Canizares M., Davis A. Health care utilization for musculoskeletal disorders. Arthr Care Res 2010; 62: 161-9.</p><p>Drossaers-Bakker K.W., de Buck M., van Zeben D. et al. Long-term course and outcome of functional capacity in rheumatoid arthritis: the effect of disease activity and radiologic damage over time. Arthr Rheum 1999; 42: 1854-60.</p><p>Wilsing P.M., van Gestel A.M., Swinkels H.L. et al. The relationship between disease activity, joint destruction, and functional capacity over the course of rheumatoid arthritis. Arthr Rheum 2001; 44: 2009-17.</p><p>Aletana D., Smolen J., Ward M.M. Measuring function in rheumatoid arthritis identifying reversible and irreversible components. Arthr Rheum 2006; 54: 2784-92.</p><p>Tanaka E., Mannalithara A., Inoue E. et al. Effisient management of rheumatoid arthritis significantly reduces long-term functional disability. Ann Rheum Dis 2008; 67: 1153-8.</p><p>Hootman J.M., Helmick C.G. Projections of US prevalence of arthritis and associated activity limitations. Arthr Rheum 2006; 54: 226-9.</p><p>Dixon T., Shaw M.E., Dieppe P. Analysis of regional variation in hip and knee joint replacement rates in England using Hospital Episodes Statistics. Public Health 2006; 120: 83-90.</p><p>Merx H., Dreinhofer K., Schrader P. et al. International variation in hip replacement rates. Ann Rheum Dis 2003; 62: 222-6.</p><p>Hawker G.A., Guan J., Croxford R. et al. A prospective population-based study of the predictors of undergoing total joint arthroplasty. Arthr Rheum 2006; 54(10): 3212-20.</p></div><br /><div><p>Насонов Е.Л. Фармакотерапия ревматоидного артрита в эру генно-инженерных биологических препаратов. Тер. арх. 2007; 5: 5-8.</p><p>Emery P., Breedveld F.C., Dougados M. et al. Early referral recommendation for newly diagnosed rheumatoid arthritis: evidence based development of a clinical guide. Ann Rheum Dis 2002; 61: 290-7.</p><p>Bruynesteyn K., Landewe R., van der Linden S., van der Heijde D. Radiography as primary outcome in rheumatoid arthritis: acceptable sample size for trials with 3 months follow-up. Ann Rheum Dis 2004; 63: 1413-8.</p><p>Van der Horst-Bruinsma I.E., Speyer I., Visser H. et al. Diagnosis and course of early onset arthritis: results of a special early arthritis clinic compared to routine patient care. Br J Rheumatol 1998; 37: 1084-8.</p><p>Чичасова Н.В., Владимиров С.А., Имаметдинова Г.Р. и др. Функциональные исходы ревматоидного артрита при различных способах противовоспалительной терапии. Науч.-практич. ревматол. 2010; 2: 30-6.</p><p>Каратеев Д. Е., Лучихина Е. Л., Тюрина Л. Н. и др. Возможности ранней диагностики ревматоидного артрита в клинической практике на современном этапе (результаты наблюдений за московской когортой больных ранним артритом в рамках программы РАДИКАЛ). Тер. арх. 2008; 80(5): 8-13.</p><p>Lineker S.C., Bell M.J., Boyle J. et al. Implementing arthritis clinical practice guidelines in primary care. Med Teach 2009; 31: 230-7.</p><p>Kumar K., Daley E., Carruthers D. et al. Delay in presentation to primary care physicians is the main reason why patients with rheumatoid arthritis are seen late by rheumatologists. Rheumatology (Oxford) 2007; 46(9): 1438-40.</p><p>Boyle E., Badley E.M., Glazier R.H. The relationship between local availability and first-time use of specialists in an arthritis population. Can J Public Health 2006; 97(3): 210-3.</p><p>Feldman D., Bernatsky S., Haggerty J. et al. Delay in consultation with specialists for persons with suspected new-onset rheumatoid arthritis: a population-based study. Arthr Rheum 2007; 57(8): 1419-25.</p><p>Arnett F.C., Edworthy S.M., Bloch D.A. et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthr Rheum 1988; 31: 315-24.</p><p>Sokka T., Mäkinen H., Hannonen P., Pincus T. Most people over age 50 in the general population do not meet ACR remission criteria or OMERACT minimal disease activity criteria for rheumatoid arthritis. Rheumatology (Oxford) 2007; 46(6): 1020-3.</p><p>MacKay C., Canizares M., Davis A. Health care utilization for musculoskeletal disorders. Arthr Care Res 2010; 62: 161-9.</p><p>Drossaers-Bakker K.W., de Buck M., van Zeben D. et al. Long-term course and outcome of functional capacity in rheumatoid arthritis: the effect of disease activity and radiologic damage over time. Arthr Rheum 1999; 42: 1854-60.</p><p>Wilsing P.M., van Gestel A.M., Swinkels H.L. et al. The relationship between disease activity, joint destruction, and functional capacity over the course of rheumatoid arthritis. Arthr Rheum 2001; 44: 2009-17.</p><p>Aletana D., Smolen J., Ward M.M. Measuring function in rheumatoid arthritis identifying reversible and irreversible components. Arthr Rheum 2006; 54: 2784-92.</p><p>Tanaka E., Mannalithara A., Inoue E. et al. Effisient management of rheumatoid arthritis significantly reduces long-term functional disability. Ann Rheum Dis 2008; 67: 1153-8.</p><p>Hootman J.M., Helmick C.G. Projections of US prevalence of arthritis and associated activity limitations. Arthr Rheum 2006; 54: 226-9.</p><p>Dixon T., Shaw M.E., Dieppe P. Analysis of regional variation in hip and knee joint replacement rates in England using Hospital Episodes Statistics. Public Health 2006; 120: 83-90.</p><p>Merx H., Dreinhofer K., Schrader P. et al. International variation in hip replacement rates. Ann Rheum Dis 2003; 62: 222-6.</p><p>Hawker G.A., Guan J., Croxford R. et al. A prospective population-based study of the predictors of undergoing total joint arthroplasty. Arthr Rheum 2006; 54(10): 3212-20.</p></div><br />

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