Прогресс и значимые изменения в подходах к диагностике и лечению артритов определяют необходимость комплексного изучения структуры и изменений сопутствующих заболеваний у больных ревматологического профиля. Цель исследования: изучение встречаемости коморбидных состояний у больных воспалительными заболеваниями позвоночника и суставов с оценкой общих изменений, которые претерпевают коморбидные состояния в начале XXI в. Материалы и методы. С применением валидированных индексов оценки коморбидности проанализирована коморбидность у 245 пациентов со спондилоартритами, участвовавших в научной программе ПРОГРЕСС. Выполнен анализ 96 источников литературных баз РИНЦ и PubMed. Результаты собственного наблюдения и литературного поиска сопоставлены и проанализированы. Результаты и обсуждение. По данным медицинской документации проведен анализ структуры коморбидной патологии у 221 больного: мультиморбидными являются 207 (93,66%) пациентов с воспалительными заболеваниями позвоночника и суставов. Наиболее распространены заболевания желудочно-кишечного тракта (60,6%) и сердечно-сосудистая патология (58,3%), вторичный остеоартрит (60,2%). По данным источников литературы, бо́льшая часть коморбидных состояний и воспалительных заболеваний позвоночника и суставов взаимосвязаны патогенетически и при изменении профиля ревматических и/или сопутствующих болезней претерпевают одновременные изменения. Появление новых заболеваний в структуре коморбидности и новых лекарственных средств требует разработки рекомендаций, учитывающих наличие коморбидной патологии у пациентов ревматологического профиля. Заключение. Большинство больных воспалительными заболеваниями позвоночника и суставов являются мультиморбидными, в связи с чем коморбидность определяет прогноз и тактику ведения пациента. Изменение ревматических и неревматических болезней, происходящее в XXI в., оказывает взаимное влияние, изменяя профиль пациентов и определяя изменение тактики их ведения.
Progress and significant changes in the approaches to the diagnosis and treatment of arthritis determine the need for a comprehensive study of comorbidities in rheumatologic patients. Aim. The evaluation the occurrence of comorbidities in patients with inflammatory diseases of the spine and joints and the assessment of the general changes in comorbidities at the beginning of the XXI century compared to previous period. Materials and methods. Comorbidity was analyzed in 245 patients with spondyloarthritis who participated in the scientific program PROGRESS. Validated comorbidity assessment indices were used in the study. The analysis of 96 sources of literary bases RISC and PubMed were used in literature analysis. The results of their own observation and literary search were compared. Results and discussion. According to the patients’ cards, an analysis of the structure of comorbidities was conducted in 221 patients: 207 (93.66%) patients with spondyloarthritis had two or more comorbidities. The most common diseases were diseases of gastrointestinal tract (60.6%) and cardiovascular pathology (58.3%), secondary osteoarthritis (60.2%). According to literature sources, most of the comorbidities and spondyloarthritis are interrelated pathogenetically and undergo a change in the profile of rheumatic and/or related diseases undergo simultaneous changes. The emergence of new diseases in the structure of comorbidity and new drugs requires the development of recommendations that take into account the presence of comorbidity in patients with a rheumatic diseases. Conclusion. Most patients with spondyloarthritis has comorbidity. The change in rheumatic and non-rheumatic diseases that occurs in the 21st century has a mutual influence, changing the profile of patients and determining the change in the tactics of their management.
1. Braun J, Krüger K, Manger B, Schneider M, Specker C, Trappe H.J. Cardiovascular Comorbidity in Inflammatory Rheumatological Conditions. Dtsch Arztebl Int. 2017;114(12):197-203. doi: 10.3238/arztebl.2017.0197
2. Van der Heijde D, Ramiro S, Landewé R, Baraliakos X, van den Bosch F, Sepriano A, Regel A, Ciurea A, Dagfinrud H, Dougados M, van Gaalen F, Géher P, van der Horst-Bruinsma I, Inman RD, Jongkees M, Kiltz U, Kvien TK, Machado PM, Marzo-Ortega H, Molto A, Navarro-Compàn V, Ozgocmen S, Pimentel-Santos FM, Reveille J, Rudwaleit M, Sieper J, Sampaio-Barros P, Wiek D, Braun J. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017. doi: 10.1136/annrheumdis-2016-210770
3. Schoels MM, Braun J, Dougados M, Emery P, Fitzgerald O, Kavanaugh A, Kvien TK, Landewé R, Luger T, Mease P, Olivieri I, Reveille J, Ritchlin C, Rudwaleit M, Sieper J, Smolen JS, Wit Md, van der Heijde D. Treating axial and peripheral spondyloarthritis, including psoriatic arthritis, to target: results of a systematic literature search to support an international treat-to-target recommendation in spondyloarthritis. Ann Rheum Dis. 2014;73(1):238-42. doi: 10.1136/annrheumdis-2013-203860
4. Wendling D. Treating to target in axial spondyloarthritis: defining the target and the arrow. Expert Rev Clin Immunol. 2015 Jun;11(6):691-3. doi: 10.1586/1744666X.2015.1039514
5. Pinheiro FA, Souza DC, Sato EI. A Study of Multiple Causes of Death in Rheumatoid Arthritis. J Rheumatol. 2015;42(12):2221-8. doi: 10.3899/jrheum.150166
6. Hippisley-Cox J, Coupland C, Brindle P. Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study. BMJ. 2017;23:357,j2099. doi: 10.1136/bmj.j2099
7. Horreau C, Pouplard C, Brenaut E, Barnetche T, Misery L, Cribier B, Jullien D, Aractingi S, Aubin F, Joly P, Le Maître M, Ortonne JP, Paul C, Richard MA.Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: a systematic literature review. J Eur Acad Dermatol Venereol. 2013 Aug;27(Suppl 3):12-29. doi: 10.1111/jdv.12163
8. Hartl A, Sieper J, Syrbe U, Listing J, Hermann KG, Rudwaleit M, Poddubnyy D. Serum levels of leptin and high molecular weight adiponectin are inversely associated with radiographic spinal progression in patients with ankylosing spondylitis: results from the ENRADAS trial. Arthritis Res Ther. 2017;19(1):140. doi: 10.1186/s13075-017-1350-9
9. Fallahi S. Relationship of smoking quantity with outcome measures in patients with ankylosing spondylitis: Comments on the article by Villaverde-García V. et al. Semin Arthritis Rheum. 2017. pii: S0049-0172(17)30175-0. doi: 10.1016/j.semarthrit.2017.03.011
10. Rudwaleit M, van der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J, Braun J, Chou CT, Collantes-Estevez E, Dougados M, Huang F, Gu J, Khan MA, Kirazli Y, Maksymowych WP, Mielants H, Sørensen IJ, Ozgocmen S, Roussou E, Valle-Oñate R, Weber U, Wei J, Sieper J.The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009 Jun;68(6):777-83. doi: 10.1136/ard.2009.108233
11. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994;21(12):2286-91.
12. Van der Heijde D, Lie E, Kvien TK, Sieper J, Van den Bosch F, Listing J, Braun J, Landewé R. ASDAS, a highly discriminatory ASAS-endorsed disease activity score in patients with ankylosing spondylitis. Ann Rheum Dis. 2009 Dec;68(12):1811-8. doi: 10.1136/ard.2008.100826
13. Machado P, Landewé R, Lie E, Kvien TK, Braun J, Baker D, van der Heijde D; Assessment of SpondyloArthritis international Society. Ankylosing Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activitystates and improvement scores. Ann Rheum Dis. 2011 Jan;70(1):47-53. doi: 10.1136/ard.2010.138594
14. Calin A, Garrett S, Whitelock H, Kennedy LG, et al. A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol. 1994;21(12):2281-5.
15. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83.
16. Kaplan MH, Feinstein AR. The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. J Chron Dis. 1974;27(7-8):387-404.
17. Conwell Y, Forbes NT, Cox C, Caine ED. Validation of a measure of physical illness burden at autopsy: the Cumulative Illness Rating Scale. J Am Geriatr Soc. 1993;41(1):38-41.
18. Реброва О.Ю. Статистический анализ медицинских данных. Применение пакета прикладных программ STATISTICA. М.: МедиаСфера, 2002 [Rebrova OYu. Statisticheskiy analiz meditsinskikh dannykh. Primenenie paketa prikladnykh programm [Statistical analysis of medical data. The application package STATISTICA applications. Moscow: Media Sphere, 2002 (In Russ.)].
19. Bengtsson K, Forsblad-d'Elia H, Lie E, Klingberg E, Dehlin M, Exarchou S, Lindström U, Askling J, Jacobsson LTH. Are ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis associated with an increased risk of cardiovascular events? A prospective nationwide population-based cohort study. Arthritis Res Ther. 2017;19(1):102. doi: 10.1186/s13075-017-1315-z
20. Moltó A, Etcheto A, van der Heijde D, Landewé R, van den Bosch F, Bautista Molano W, Burgos-Vargas R, Cheung PP, Collantes-Estevez E, Deodhar A, El-Zorkany B, Erdes S, Gu J, Hajjaj-Hassouni N, Kiltz U, Kim TH, Kishimoto M, Luo SF, Machado PM, Maksymowych WP, Maldonado-Cocco J, Marzo-Ortega H, Montecucco CM, Ozgoçmen S, van Gaalen F, Dougados M. Prevalence of comorbidities and evaluation of their screening in spondyloarthritis: results of the international cross-sectional ASAS-COMOSPA study. Ann Rheum Dis. 2016;75(6):1016-23. doi: 10.1136/annrheumdis-2015-208174
21. Dougados M, Soubrier M, Antunez A, Balint P, Balsa A, Buch MH, Casado G, Detert J, El-Zorkany B, Emery P, Hajjaj-Hassouni N, Harigai M, Luo SF, Kurucz R, Maciel G, Mola EM, Montecucco CM, McInnes I, Radner H, Smolen JS, Song YW, Vonkeman HE, Winthrop K, Kay J. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis. 2014;73(1):62-8. doi: 10.1136/annrheumdis-2013-204223
22. Van Doornum S, Bohensky M, Tacey MA, Brand CA, Sundararajan V, Wicks IP. Increased 30-day and 1-year mortality rates and lower coronary revascularisation rates following acute myocardial infarction in patients with autoimmune rheumatic disease. Arthritis Res Ther. 2015;17:38. doi: 10.1186/s13075-015-0552-2
23. Подряднова М.В., Эрдес Ш.Ф., Дубинина Т.В., Старкова А.С., Красненко С.О., Урумова М.М., Агафонова Е.М., Балабанова Р.М. Мультиморбидность анкилозирующего спондилита – результаты российского исследования, проведенного в рамках международной программы COMOSPA. Научно-практическая ревматология. 2016;54(S1):123-4 [Podryadnova MV, Erdes ShF, Dubinina TV, Starkova AS, Krasnenko SO, Urumova MM, Agafonova EM, Balabanova RM. Multimorbidity in ankylosing spondylitis – results of a Russian study conducted within the framework of the international COMOSPA program. Nauchno-Prakticheskaya Revmatologiya. 2016;54(S1):123-4 (In Russ.)].
24. Yen YF, Jen IA, Chen M, Lan YC, Lee CY, Chuang PH, Lee Y, Arthur Chen YM. Human Immunodeficiency Virus Infection Increases the Risk of Incident Psoriasis: A Nationwide Population-based Cohort Study in Taiwan. J Acquir Immune Defic Syndr. 2017. doi: 10.1097/QAI.0000000000001431
25. Bardazzi F, Magnano M, Campanati A, Loconsole F, Carpentieri A, Potenza C, Bernardini N, Di Lernia V, Carrera C, Raone B, Patrizi A, Loi C. Biologic Therapies in HIV-infected Patients with Psoriasis: An Italian Experience. Acta Derm Venereol. 2017. doi: 10.2340/00015555-2698
26. Fink DL, Hedley L, Miller RF. Systematic review of the efficacy and safety of biological therapy for inflammatory conditions in HIV-infected individuals. Int J STD AIDS. 2017;28(2):110-9. doi: 10.1177/0956462416675109
27. Dey AK, Joshi AA, Chaturvedi A, Lerman JB, Aberra TM, Rodante JA, Teague HL, Harrington CL, Rivers JP, Chung JH, Kabbany MT, Natarajan B, Silverman JI, Ng Q, Sanda GE, Sorokin AV, Baumer Y, Gerson E, Prussick RB, Ehrlich A, Green LJ, Lockshin BN, Ahlman MA, Playford MP, Gelfand JM, Mehta NN. Association Between Skin and Aortic Vascular Inflammation in Patients With Psoriasis: A Case-Cohort Study Using Positron Emission Tomography/Computed Tomography. JAMA Cardiol. 2017. doi: 10.1001/jamacardio.2017.1213
________________________________________________
1. Braun J, Krüger K, Manger B, Schneider M, Specker C, Trappe H.J. Cardiovascular Comorbidity in Inflammatory Rheumatological Conditions. Dtsch Arztebl Int. 2017;114(12):197-203. doi: 10.3238/arztebl.2017.0197
2. Van der Heijde D, Ramiro S, Landewé R, Baraliakos X, van den Bosch F, Sepriano A, Regel A, Ciurea A, Dagfinrud H, Dougados M, van Gaalen F, Géher P, van der Horst-Bruinsma I, Inman RD, Jongkees M, Kiltz U, Kvien TK, Machado PM, Marzo-Ortega H, Molto A, Navarro-Compàn V, Ozgocmen S, Pimentel-Santos FM, Reveille J, Rudwaleit M, Sieper J, Sampaio-Barros P, Wiek D, Braun J. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017. doi: 10.1136/annrheumdis-2016-210770
3. Schoels MM, Braun J, Dougados M, Emery P, Fitzgerald O, Kavanaugh A, Kvien TK, Landewé R, Luger T, Mease P, Olivieri I, Reveille J, Ritchlin C, Rudwaleit M, Sieper J, Smolen JS, Wit Md, van der Heijde D. Treating axial and peripheral spondyloarthritis, including psoriatic arthritis, to target: results of a systematic literature search to support an international treat-to-target recommendation in spondyloarthritis. Ann Rheum Dis. 2014;73(1):238-42. doi: 10.1136/annrheumdis-2013-203860
4. Wendling D. Treating to target in axial spondyloarthritis: defining the target and the arrow. Expert Rev Clin Immunol. 2015 Jun;11(6):691-3. doi: 10.1586/1744666X.2015.1039514
5. Pinheiro FA, Souza DC, Sato EI. A Study of Multiple Causes of Death in Rheumatoid Arthritis. J Rheumatol. 2015;42(12):2221-8. doi: 10.3899/jrheum.150166
6. Hippisley-Cox J, Coupland C, Brindle P. Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study. BMJ. 2017;23:357,j2099. doi: 10.1136/bmj.j2099
7. Horreau C, Pouplard C, Brenaut E, Barnetche T, Misery L, Cribier B, Jullien D, Aractingi S, Aubin F, Joly P, Le Maître M, Ortonne JP, Paul C, Richard MA.Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: a systematic literature review. J Eur Acad Dermatol Venereol. 2013 Aug;27(Suppl 3):12-29. doi: 10.1111/jdv.12163
8. Hartl A, Sieper J, Syrbe U, Listing J, Hermann KG, Rudwaleit M, Poddubnyy D. Serum levels of leptin and high molecular weight adiponectin are inversely associated with radiographic spinal progression in patients with ankylosing spondylitis: results from the ENRADAS trial. Arthritis Res Ther. 2017;19(1):140. doi: 10.1186/s13075-017-1350-9
9. Fallahi S. Relationship of smoking quantity with outcome measures in patients with ankylosing spondylitis: Comments on the article by Villaverde-García V. et al. Semin Arthritis Rheum. 2017. pii: S0049-0172(17)30175-0. doi: 10.1016/j.semarthrit.2017.03.011
10. Rudwaleit M, van der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J, Braun J, Chou CT, Collantes-Estevez E, Dougados M, Huang F, Gu J, Khan MA, Kirazli Y, Maksymowych WP, Mielants H, Sørensen IJ, Ozgocmen S, Roussou E, Valle-Oñate R, Weber U, Wei J, Sieper J.The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009 Jun;68(6):777-83. doi: 10.1136/ard.2009.108233
11. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994;21(12):2286-91.
12. Van der Heijde D, Lie E, Kvien TK, Sieper J, Van den Bosch F, Listing J, Braun J, Landewé R. ASDAS, a highly discriminatory ASAS-endorsed disease activity score in patients with ankylosing spondylitis. Ann Rheum Dis. 2009 Dec;68(12):1811-8. doi: 10.1136/ard.2008.100826
13. Machado P, Landewé R, Lie E, Kvien TK, Braun J, Baker D, van der Heijde D; Assessment of SpondyloArthritis international Society. Ankylosing Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activitystates and improvement scores. Ann Rheum Dis. 2011 Jan;70(1):47-53. doi: 10.1136/ard.2010.138594
14. Calin A, Garrett S, Whitelock H, Kennedy LG, et al. A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol. 1994;21(12):2281-5.
15. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83.
16. Kaplan MH, Feinstein AR. The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. J Chron Dis. 1974;27(7-8):387-404.
17. Conwell Y, Forbes NT, Cox C, Caine ED. Validation of a measure of physical illness burden at autopsy: the Cumulative Illness Rating Scale. J Am Geriatr Soc. 1993;41(1):38-41.
18. [Statistical analysis of medical data. The application package STATISTICA applications. Moscow: Media Sphere, 2002 (In Russ.)].
19. Bengtsson K, Forsblad-d'Elia H, Lie E, Klingberg E, Dehlin M, Exarchou S, Lindström U, Askling J, Jacobsson LTH. Are ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis associated with an increased risk of cardiovascular events? A prospective nationwide population-based cohort study. Arthritis Res Ther. 2017;19(1):102. doi: 10.1186/s13075-017-1315-z
20. Moltó A, Etcheto A, van der Heijde D, Landewé R, van den Bosch F, Bautista Molano W, Burgos-Vargas R, Cheung PP, Collantes-Estevez E, Deodhar A, El-Zorkany B, Erdes S, Gu J, Hajjaj-Hassouni N, Kiltz U, Kim TH, Kishimoto M, Luo SF, Machado PM, Maksymowych WP, Maldonado-Cocco J, Marzo-Ortega H, Montecucco CM, Ozgoçmen S, van Gaalen F, Dougados M. Prevalence of comorbidities and evaluation of their screening in spondyloarthritis: results of the international cross-sectional ASAS-COMOSPA study. Ann Rheum Dis. 2016;75(6):1016-23. doi: 10.1136/annrheumdis-2015-208174
21. Dougados M, Soubrier M, Antunez A, Balint P, Balsa A, Buch MH, Casado G, Detert J, El-Zorkany B, Emery P, Hajjaj-Hassouni N, Harigai M, Luo SF, Kurucz R, Maciel G, Mola EM, Montecucco CM, McInnes I, Radner H, Smolen JS, Song YW, Vonkeman HE, Winthrop K, Kay J. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis. 2014;73(1):62-8. doi: 10.1136/annrheumdis-2013-204223
22. Van Doornum S, Bohensky M, Tacey MA, Brand CA, Sundararajan V, Wicks IP. Increased 30-day and 1-year mortality rates and lower coronary revascularisation rates following acute myocardial infarction in patients with autoimmune rheumatic disease. Arthritis Res Ther. 2015;17:38. doi: 10.1186/s13075-015-0552-2
23. [Podryadnova MV, Erdes ShF, Dubinina TV, Starkova AS, Krasnenko SO, Urumova MM, Agafonova EM, Balabanova RM. Multimorbidity in ankylosing spondylitis – results of a Russian study conducted within the framework of the international COMOSPA program. Nauchno-Prakticheskaya Revmatologiya. 2016;54(S1):123-4 (In Russ.)].
24. Yen YF, Jen IA, Chen M, Lan YC, Lee CY, Chuang PH, Lee Y, Arthur Chen YM. Human Immunodeficiency Virus Infection Increases the Risk of Incident Psoriasis: A Nationwide Population-based Cohort Study in Taiwan. J Acquir Immune Defic Syndr. 2017. doi: 10.1097/QAI.0000000000001431
25. Bardazzi F, Magnano M, Campanati A, Loconsole F, Carpentieri A, Potenza C, Bernardini N, Di Lernia V, Carrera C, Raone B, Patrizi A, Loi C. Biologic Therapies in HIV-infected Patients with Psoriasis: An Italian Experience. Acta Derm Venereol. 2017. doi: 10.2340/00015555-2698
26. Fink DL, Hedley L, Miller RF. Systematic review of the efficacy and safety of biological therapy for inflammatory conditions in HIV-infected individuals. Int J STD AIDS. 2017;28(2):110-9. doi: 10.1177/0956462416675109
27. Dey AK, Joshi AA, Chaturvedi A, Lerman JB, Aberra TM, Rodante JA, Teague HL, Harrington CL, Rivers JP, Chung JH, Kabbany MT, Natarajan B, Silverman JI, Ng Q, Sanda GE, Sorokin AV, Baumer Y, Gerson E, Prussick RB, Ehrlich A, Green LJ, Lockshin BN, Ahlman MA, Playford MP, Gelfand JM, Mehta NN. Association Between Skin and Aortic Vascular Inflammation in Patients With Psoriasis: A Case-Cohort Study Using Positron Emission Tomography/Computed Tomography. JAMA Cardiol. 2017. doi: 10.1001/jamacardio.2017.1213
Авторы
И.З. Гайдукова 1, А.И. Акулова 2, А.П. Ребров 2
1ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России, Санкт-Петербург, Россия;
2 ФГБОУ ВО «Саратовский государственный медицинский университет им. В.И. Разумовского» Минздрава России, Саратов, Россия
________________________________________________
I.Z. Gaydukova 1, A.I. Akulova 2, A.P. Rebrov 2
1 I.I. Mechnikov North-Western State Medical University of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russia;
2 V.I. Razumovsky Saratov State Medical University of the Ministry of Health of the Russian Federation, Saratov, Russia