СОВРЕМЕННЫЙ ВЗГЛЯД НА БОЛЕЗНЬ ХОРТОНА: АНАЛИЗ СЛУЧАЕВ В ХАБАРОВСКОМ КРАЕ
Аннотация
Цель – проанализировать заболеваемость гигантоклеточным артритом (ГКА) в Хабаровском крае.
Материал и методы. Представлен анализ 10 случаев (11,6%) ГКА, выявленных в ходе 20-летнего проспективного наблюдения
и лечения 89 больных ревматической полимиалгией (РП) и ГКА. Определена частота отдельных диагностических критериев ГКА, описан дебют болезни, параклинические данные. В исследование были включены женщины в возрасте 67,3±2,1 [59; 76] года.
Результаты и обсуждение. Сочетание ГКА с РП отмечалось в 70% случаев. Помимо темпорального артериита наблюдалась клиническая картина поражения теменных (50%), глазных (30%), затылочных (30%), коронарных (10%) артерий. Поражение скальпа с образованием некроза теменной области выявлено в одном случае. Диагноз выставлен в среднем через 7,1±1,6 мес.
У всех отмечалось повышение СОЭ, в среднем до 110,2±3,1 по Вестергрену. 7 пациентов получали лечение преднизолоном 1,0 мг/кг массы тела, 3 больных (ввиду противопоказаний) – 0,5 мг/кг в сочетании с пульс-терапией циклофосфаном по 1000 мг внутривенно капельно один раз в месяц. Через 4 мес вследствие нарушения мозгового кровообращения умерла одна пациентка. В отдаленном периоде отмечено развитие остеопороза с переломами – в двух случаях, у двух пациенток сахарный диабет и артериальная гипертензия, у одной больной – рак шейки матки (успешно леченный). Потеря зрения наблюдалась у одной пациентки, диагноз которой был установлен спустя 1,5 года.
Список литературы
1. <div><p>Бунчук Н.В. Ревматические заболевания пожилых. М.: МЕДпрессинформ, 2010; с. 6-136</p><p>Насонов Е.Л., Баранов А.А., Шиллкина Н.П. Васкулиты и васкулопатии. Ярославль: Верхняя Волга, 1999; 614 с</p><p>Ревматология: Национальное руководство. Под ред. Е.Л. Насонова, В.А. Насоновой. М.: ГЭОТАР-Медиа, 2008;714 с.</p><p>Horton B.T., Magath T.B., Brown G.E. An undescribed form of arteritis of the temporal vessels. Mayo Clin Proc 1932;7:700-1.</p><p>Weyand C.M., Goronzy J.J. Arterial wall injury in giant cell arteritis. Arthr Rheum 1999;42:844-53.</p><p>Weyand C.M., Goronzy J.J. Mediumand large-vessel vasculitis. N Engl J Med 2003;349:160-9.</p><p>Evans J.M., Hunder G.G. Polymyalgia rheumatica and giant cell arteritis. Rheum Dis Clin North Am 2000;26:493-515.</p><p>Uddhammar A., Eriksson A.L., Nystrom L. et al. Increased mortality due to cardiovascular disease in patients with giant cell arteritis in northern Sweden. J Rheumatol 2002;29:737-42.</p><p>Franzеn P., Sutinen S., von Knorring J. Giant cell arteritis and polymyalgia rheumatica in a region of Finland: an epidemiologic, clinical and pathologic study, 1984-1988. J Rheumatol 1992;19:273-6.</p><p>Hunder G.G. Epidemiology of giant cell arterits. Cleve Clin J Med 2002;69(Suppl. 2):S1179-S1182</p><p>Lawrence R.C., Helmick C.G., Arnett F.C. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthr Rheum 1998;41:778-99.</p><p>Machado E.B., Michet C.J., Ballard D.J. et al. Trends in incidence and clinical presentation of temporal arteritis in Olmsted County, Minnesota, 1950-1985. Arthr Rheum 1988;31:745-9.</p><p>Gay M.A., Alonso M.D., Aguero J.J. et al. Temporal arteritis in a northwestern area of Spain: study of 57 biopsy proven patients. J Rheumatol 1992;19:277-80.</p><p>Smeeth L., Cook C., Hall A.J. Incidence of diagnosed polymyalgia rheumatica and temporal arteritis in the United Kingdom, 1990 to 2001. Ann Rheum Dis 2006;65:1093-8.</p><p>Dababneh A., Gonzalez-Gay M.A., Garcia-Porrua C. et al. Giant cell arteritis and polymyalgia rheumatica can be differentiated by distinct patterns of HLA class II association. J Rheumatol 1998;25:2140-5.</p><p>Wagner A.D., Bjornsson J., Bartley G.B. et al. Interferon-gamma-producing T cells in giant cell vasculitis represent a minority of tissue infiltrating cells and are located distant from the site of pathology. Am J Pathol 1996;148:1925-33.</p><p>Weyand C.M., Hicok K.C., Hunder G.G., Goronzy J.J. The HLA-DRB1 locus as a genetic component in giant cell arteritis. Mapping of a disease-linked sequence motif to the antigen binding site of the HLA-DR molecule. J Clin Invest 1992;90:2355-61.</p><p>Weyand C.M., Hunder N.N., Hicok K.C. et al. Comparison of polymyalgia rheumatica, giant cell arteritis and rheumatoid arthritis by genetic linkage analysis. Arthr Rheum 1994;37:514-20</p><p>Weyand C.M., Hicok K.C., Hunder G.G., Goronzy J.J. Tissue cytokine patterns in patients with polymyalgia rheumatica and giant cell arteritis. Ann Intern Med 1994;121:484-91</p><p>Weyand C.M., Tetzlaff N., Bjornsson J. et al. Disease patterns and tissue cytokine profiles in giant cell arteritis. Arthr Rheum 1997;40:19-26.</p><p>Weyand C.M., Goronzy J.J. Giant-Cell Arteritis and Polymyalgia Rheumatica. Ann Inter Med 2003;139:505-15</p><p>Hunder G.G., Valente R.M. Giant cell arteritis: Clinical aspects. In: Hoffman G.S., Weyand C.M., eds. Inflammatory Diseases of Blood Vessels. New York: Marcel Dekker, 2002;425-41.</p><p>Hunder G.G., Bloch D.A., Michel B.A. et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthr Rheum 1990;33:1122-8.</p><p>Leeb B.F., Bird H.A. A disease activity score for polymyalgia rheumatica. Ann Rheum Dis 2004;63(10):1279-83.</p><p>Leeb B.F., Bird H.A., Nesher G. et al. EULAR response criteria for polymyalgia rheumatica: results of an initiative of the European collaborating Polymyalgia Rheumatica group (subcommittee of ESCISIT). Ann Rheum Dis 2003;62:1189-94.</p><p>Leeb B.F., Rintelen B., Sautner J. The Polymyalgia Rheumatica Activity Score in Daily Use: Proposal for a Definition of Remission. Arthr Rheum (Arthr Care Res) 2007;57(5):810-5.</p><p>Leeb B.F. Disease activity assessment in polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) [abstract]. Rheumatology (Oxford) 2005;44 (Suppl. 3): 5-6.</p><p>Achkar A.A., Hunder G.G., Gabriel S.E. Effect of previous corticosteroid treatment on temporal artery biopsy results [Letter]. Ann Intern Med 1998;128:410</p><p>Brack A., Martinez-Taboada V., Stanson A. et al. Disease pattern in cranial and large-vessel giant cell arteritis. Arthr Rheum 1999;42:311-7.</p><p>Ghanchi F.D., Dutton G.N. Current concepts in giant cell (temporal) arteritis. Surv Ophthalmol 1997;42:99-123.</p><p>Nesher G., Nesher R., Rozenman Y., Sonnenblick M. Visual hallucinations in giant cell arteritis: association with visual loss. J Rheumatol 2001;28:2046-8.</p><p>Liu G.T., Glaser J.S., Schatz N.J., Smith J.L. Visual morbidity in giant cell arteritis. Clinical characteristics and prognosis for vision. Ophthalmology 1994;101:1779-85.</p><p>Levine S.M., Hellmann D.B. Giant cell arteritis. Curr Opin Rheumatol 2002;14:3-10</p><p>Tovilla-Canales J.L. Ocular manifestations of giant cell arteritis. Curr Opin Ophthalmol 1998;9:73-9.</p><p>Evans J.M., O'Fallon W.M., Hunder G.G. Increased incidence of aortic aneurysm and dissection in giant cell (temporal) arteritis. A population-based study. Ann Intern Med 1995;122:502-7</p><p>Evans J.M., Bowles C.A., Bjornsson J. et al. Thoracic aortic aneurysm and rupture in giant cell arteritis. A descriptive study of 41 cases. Arthr Rheum 1994;37: 1539-47</p><p>Salvarani C., Cantini F., Boiardi L., Hunder G.G. Polymyalgia rheumatica and giant-cell arteritis [review]. N Engl J Med 2002;347:261-71.</p><p>Weyand C.M., Goronzy J.J. Arterial wall injury in giant cell arteritis. Arthr Rheum 1999;42:844-53.</p><p>Cantini F., Salvarani C., Olivieri I. et al. Shoulder ultrasonography in the diagnosis of polymyalgia rheumatica: a case control study. J Rheumatol 2001;28:1049-55.</p><p>Nordborg E., Nordborg C., Bengtsson B.A. Giant cell arteritis. Curr Opin Rheumatol 1992;4:23-30</p><p>Cantini F., Salvarani C., Olivieri I. et al. Erythrocyte sedimentation rate and C-reactive protein in the evaluation of disease activity and severity in polymyalgia rheumatica: a prospective follow-up study. Semin Arthr Rheum 2000;30:17-24.</p><p>Jones J.G., Hazleman B.L. ESR in polymyalgia rheumatica and giant cell arteritis [Letter]. Ann Rheum Dis 1983;42:702-3.</p><p>Martinez-Taboada V.M. Giant cell arteritis with an erythrocyte sediemtation rate lower than 50. Clin Rheumatol 2000;19:73-5.</p><p>Salvarani C., Hunder G.G. Giant cell arteritis with low erythrocyte sedimentation rate: frequency of occurence in a populationbased study. Arthr Rheum 2001;45:140-5.</p><p>Seo Ph., Stone J. Large-Vessel Vasculitis. Arthr Rheum 2004;15:128-39.</p><p>Gonzales-Gay M.A., Garcia-Porrua C., Vazquez-Caruncho M. Polymyalgia rheumatica in biopsy proven giant cell arteritis does not constitute a different subset but differs from isolated polymyalgia rheumatica. J Rheumatol 1998;25:1750-5.</p><p>Genereau T., Lortholary O., Pottier M.A. et al. Temporal artery biopsy: a diagnostic tool for systemic necrotizing vasculitis. French Vasculitis Study Group. Arthr Rheum 1999;42:2674-81.</p><p>Foroozan R., Danesh-Meyer H., Savino P.J. Thrombocytosis in patients with biopsy-proven giant cell arteritis. Ophthalmology 2002;109:1267-71</p><p>Lie J.T. Temporal artery biopsy diagnosis of giant cell arteritis: lessons from 1109 biopsies. Anat Pathol 1996;1:69-97.</p><p>Duhaut P., Pinede L., Bornet H. et al. Biopsy proven and biopsy negative temporal arteritis: differences in clinical spectrum at the onset of the disease. Ann Rheum Dis 1999;58:335-41</p><p>Allison M., Gallagher P. Temporal artery biopsy and corticosteroid treatment. Ann Rhem Dis 1984;43:416-7</p><p>Schmidt W.A., Gromnica-Ihle E. Incidence of temporal arteritis in patients with polymyalgia rheumatica: a prospective study using colour Doppler ultrasonography of the temporal arteries. Rheumatology 2002;4:46-52.</p><p>Schmidt W.A. Doppler ultrasonography in the diagnosis of giant cell arteritis. Clin Exp Rheumatol 2000;18(Suppl. 20):40-2.</p><p>Birkhead N.C., Wagener H.P., Schick R.M. Treatment of temporal arteritis with adrenal corticosteroids: Results in 55 cases in which lesion was proven at biopsy. JAMA 1957;163:821-7</p><p>Myklebust G., Gran J.T. Prednisolone maintenance dose in relation to starting dose in the treatment of polymyalgia rheumatica and temporal arteritis. A prospective twoyear study in 273 patients. Scand J Rheumatol 2001;30:260-7.</p><p>Jover J.A., Hernandez-Garcia C., Morado I.C. et al. Combined treatment of giant-cell arteritis with methotrexate and prednisone. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 2001;134:106-14.</p><p>Krall P.L., Mazanec D.J., Wilke W.S. Methotrexate for corticosteroidresistant polymyalgia rheumatica and giant cell arteritis. Cleve Clin J Med 1989;56:253-7.</p><p>Spiera R.F., Mitnick H.J., Kupersmith M. et al. A prospective, doubleblind, randomized, placebo controlled trial of methotrexate in the treatment of giant cell arteritis (GCA). Clin Exp Rheumatol 2001;19:495-501.</p><p>Weyand C.M., Kaiser M., Yang H. et al. Therapeutic effects of acetylsalicylic acid in giant cell arteritis. Arthr Rheum 2002;46:457-66.</p><p>Weyand C.M., Fulbright J.W., Hunder G.G. et al. Treatment of giant cell arteritis: interleukin-6 as a biologic marker of disease activity. Arthr Rheum 2000;43:1041-8.</p><p>Hagihara K., Kawase I., Tanaka T., Kishimoto Т. Tocilizumab Ameliorates Clinical Symptoms in Polymyalgia Rheumatica. J Rhematol 2010;37(5):1075-6.</p></div><br />
Для цитирования:
Оттева Э.Н., Кочерова Т.Ю. СОВРЕМЕННЫЙ ВЗГЛЯД НА БОЛЕЗНЬ ХОРТОНА: АНАЛИЗ СЛУЧАЕВ В ХАБАРОВСКОМ КРАЕ. Научно-практическая ревматология. 2011;49(5):38-45. https://doi.org/10.14412/1995-4484-2011-1459
For citation:
Otteva E.N., Kocherova T.Yu. CURRENT VIEW OF HORTON'S DISEASE: ANALYSIS OF ITS CASES IN THE KHABAROVSK TERRITORY. Rheumatology Science and Practice. 2011;49(5):38-45. (In Russ.) https://doi.org/10.14412/1995-4484-2011-1459
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