Обоснование. Псориатический артрит (ПсА) – комплексное иммуноопосредованное заболевание, при котором у больных псориазом (Пс) наблюдаются воспалительное поражение мышечно-скелетной системы (периферические суставы и аксиальные структуры) и экстраартикулярные проявления (дактилиты, энтезиты, Пс ногтей, воспалительные заболевания кишечника). Цель. Оценить бремя прогрессирования ПсА в реальной практике по данным Общероссийского регистра больных. Материалы и методы. В Общероссийском регистре больных наблюдаются 737 больных ПсА: М/Ж – 350 (47,5%)/387 (52,5%). Средний возраст – 47,4±12,7 года, длительность Пс – 200,6±158,9 мес, ПсА – 79,6±81,9 мес. Больные разделены на 2 группы по длительности ПсА: 1-я группа ≤36 мес – 288 (39,1%) и 2-я группа >36 мес – 449 (60,9%). Определялись число болезненных (из 68) и припухших (из 66) суставов, индексы DAPSA, LEI, болезненность плантарной фасции, HAQ-DI, PsAID-12, тяжесть Пс, индекс массы тела (кг/м2), скорость оседания эритроцитов (мм/ч), С-реактивный белок (мг/л), сопутствующие заболевания по Международной классификации болезней 10-го пересмотра. Применялись параметрические и непараметрические методы статистического анализа. Различия считались статистически значимыми при p<0,05. Результаты. У пациентов с длительностью ПсА>36 мес значимо чаще выявлялись эрозии суставов по рентгенологическим данным, аксиальный ПсА, индекс массы тела >30 кг/м2, HAQ-DI>1, PsAID-12>4, артериальная гипертензия, метаболический синдром и общая коморбидность по сравнению с группой больных с меньшей длительностью заболевания (p<0,05). Не выявлено различий между группами по степени тяжести Пс (BSA>3%, PASI>1), LEI>1, числу болезненных суставов, числу припухших суставов, дактилиту, скорости оседания эритроцитов >30 мм/ч, С-реактивному белку >10 мг/л, DAPSA, частоте сахарного диабета, гиперлипидемии, ишемической болезни сердца и поражению печени (р>0,05). Заключение. Длительно текущий ПсА сопровождается развитием эрозий, аксиального поражения, функциональной недостаточностью, увеличением частоты общей сопутствующей патологии. Наши результаты подтверждают идею о назначении генно-инженерных базисных препаратов на ранней стадии ПсА, что может улучшить прогноз заболевания.
Background. Psoriatic arthritis (PsA) is a complex immune-mediated disease in which a third of patients with psoriasis (PsO) have a inflammatory lesion of both the musculoskeletal system (peripheral joints and axial structures) and extra-articular manifestations (dactylitis, enthesitis, nail PsO, uveitis and inflammatory bowel disease). Aim. To assess the burden of PsA progression in real practice according to the Russian register of PsA patients. Materials and methods. Seven hundred thirty seven – M/F=350 (47.5%)/387 (52.5%) – patients with PsA from the Russian register of PsA patients were included. Mean age 47.4±12.7 yrs., duration of PsO 200.6±158.9 mo., PsA – 79.6±81.9 mo. All patients were divided into 2 groups by PsA duration: 1st gr ≤36 mo – 288 (39.1%) and 2nd gr >36 mo – 449 (60.9%). All patients underwent standard clinical examination of PsA activity. Tender (68) and swelling (66) joint count (TJC, SJC), DAPSA, LEI, tenderness of the plantar fascia, PsO BSA (%), PASI, HAQ-DI, PsAID-12, BMI (kg/m2), ESR (mm/h), CRP (mg/l) and comorbidities by ICD-10 were evaluated. Parametric and non-parametric methods of statistical analysis were used. All p<0.05 were considered to indicate statistical significance. Results. In patients with PsA duration >36 mo we found significant prevalence of erosions by X-Ray, axial PsA, BMI>30 kg/m2, HAQ-DI>1, PsAID-12>4, arterial hypertension, metabolic syndrome and overall comorbidity (p<0.05). There were no significant differences between groups in PsO severity by BSA>3%, PASI>1, LEI>1, TJC, SJC, dactylitis, ESR>30 mm/h, CRP>10 mg/l, DAPSA, diabetes mellitus, hyperlipidemia, coronary heart disease and liver damage (p>0.05). Сonclusion. Long-standing stage PsA is associated with erosions, axial PsA, worst health related quality of life, functional disability and increased cardio-metabolic disorders and overall comorbidity. Our results support the idea to start bDMARDs at early stage of PsA, it can improve better outcomes.
Keywords: psoriatic arthritis, burden of progression, registry
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2. Pittam B, Gupta S, Harrison NL, et al. Prevalence of extra-articular manifestations in psoriatic arthritis: a systematic review and meta-analysis. Rheumatology. 2020;59:2199-206. DOI:10.1093/rheumatology/keaa062
3. Gladman DD, Antoni C, Mease P, et al. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis. 2005;64(Suppl. II):ii14-7. DOI:10.1136/ARD.2004.032482
4. Wu D, Griffith JF, Lam SHM, et al. Progressive structural bone changes and their relationship with treatment in patients with psoriatic arthritis: a longitudinal HRpQCT study. Arthritis Res Ther. 2019;21:265. DOI:10.1186/s13075-019-2043-3
5. Geijer M, Lindqvist U, Husmark T, et al. The Swedish Early Psoriatic Arthritis Registry 5-year followup: substantial radiographic progression mainly in men with high disease activity and development of dactylitis. J Rheumatol. 2015;42:2110-7. DOI:10.3899/jrheum.150165
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7. Mease PJ, Palmer JB, Liu M, et al. Influence of axial involvement on clinical characteristics of psoriatic arthritis: analysis from the Corrona Psoriatic Arthritis/Spondyloarthritis Registry. J Rheumatol. 2018;45(10):1389-96. DOI:10.3899/ jrheum.171094
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9. Chandran V, Tolusso DC, Cook RJ, et al. Risk factors for axial inflammatory arthritis in patients with psoriatic arthritis. J Rheumatol. 2010;37(4):809-15. DOI:10.3899/jrheum.091059
10. Haroon M, Winchester R, Giles JT. et al. Clinical and genetic associations of radiographic sacroiliitis and its different patterns in psoriatic arthritis. Clin Exp Rheumatol. 2017;35(2):270-6.
11. Губарь Е.Е., Логинова Е.Ю., Корсакова Ю.Л., и др. Особенности поражения аксиального скелета при псориатическом артрите: данные реальной клинической практики. Научно-практическая ревматология. 2020;58(4):401-6 [Gubar EE, Loginova EYu, Kоrsakova YuL, et al. Specific features of axial involvement in psoriatic arthritis: data from real clinical practice. Rheumatology Science and Practice. 2020;58(4):401-6 (in Russian)]. DOI:10.47360/1995-4484-2020-401-406
12. Gossec L, Baraliakos X, Kerschbaumer A, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis. 2020;79:700-12. DOI:10.1136/annrheumdis-2020-217159
13. Mease PJ, Karki C, Palmer JB, et al. Clinical Characteristics, Disease Activity, and Patient-Reported Outcomes in Psoriatic Arthritis Patients With Dactylitis or Enthesitis: Results From the Corrona Psoriatic Arthritis/Spondyloarthritis Registry. Arthritis Care Res. (Hoboken). 2017;69:1692-9. DOI:10.1002/ACR.23249
14. Логинова Е.Ю., Коротаева Т.В., Губарь Е.Е., и др. Влияние длительности псориатического артрита на достижение ремиссии и минимальной активности болезни на фоне терапии генно-инженерными биологическими препаратами. Данные Общероссийского регистра пациентов с псориатическим артритом. Научно-практическая ревматология. 2020;58(6):695-700 [Loginova EYu, Korotaeva TV, Gubar EE, et al. Influence of the duration of psoriatic arthritis on the achievement of remission and minimal disease activity during therapy with genetically engineered biologic drugs. Data from the All-Russian register of patients with psoriatic arthritis. Rheumatology Science and Practice. 2020;58(6):695-700 (in Russian)]. DOI:10.47360/1995-4484-2020-695-700
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17. Smolen JS, Siebert S, Korotaeva TV, et al. Effectiveness of IL-12/23 inhibition (ustekinumab) versus tumour necrosis factor inhibition in psoriatic arthritis: observational PsABio study results. Ann Rheum Dis. 2021;80(11):1419-28. DOI:10.1136/annrheumdis-2021-220263
18. Корсакова Ю.Л., Коротаева Т.В., Логинова Е.Ю., и др. Взаимосвязь ожирения, кардиометаболических нарушений и активности заболевания у больных псориатическим артритом: данные Общероссийского регистра. Терапевтический архив. 2021;93(5):573-80 [Korsakova YuL, Korotaeva TV, Loginova EIu, et al. The relationship between obesity, cardiometabolic disorders and disease activityin psoriatic arthritis patients: data from the Russian register. Terapevticheskii Arkhiv (Ter. Arkh.). 2021;93(5):573-80 (in Russian)]. DOI:10.26442/00403660.2021.05.200789
19. Haddad A, Saliba W, Lavi I, et al. The association of psoriatic arthritis with all-cause of mortality and leading causes of death in psoriatic arthritis. J Rheumatol. 2022;49(2):165-70. DOI:10.3899/JRHEUM.210159
20. Tekin HG, Wu JJ, Burge R, et al. Burden and Disease Characteristics of Patients with Psoriatic Arthritis: A Population-based Cross-sectional Study. J Rheumatol. 2019;46(7):716-20. DOI:10.3899/jrheum.180670
21. Gisondi P, Bellinato F, Targher G, et al. Biological disease-modifying antirheumatic drugs may mitigate the risk of psoriatic arthritis in patients with chronic plaque psoriasis. Ann Rheum Dis. 2022;81(1):68-73. DOI:10.1136/annrheumdis-2021-219961
22. Burgos-Pol R, Martinez-Sesmero JM, Ventura-Cerda JM, et al. The Cost of Psoriasis and Psoriatic Arthritis in 5 European Countries: A Systematic Review. Actas dermosifiliogr. 2016;107:577-90. DOI:10.1016/j.ad.2016.04.018
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1. Ritchlin CT, Colbert RA, Gladman DD. Psoriatic arthritis. N Engl J Med. 2017;376:2095-6. DOI:10.1056/NEJMra1505557
2. Pittam B, Gupta S, Harrison NL, et al. Prevalence of extra-articular manifestations in psoriatic arthritis: a systematic review and meta-analysis. Rheumatology. 2020;59:2199-206. DOI:10.1093/rheumatology/keaa062
3. Gladman DD, Antoni C, Mease P, et al. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis. 2005;64(Suppl. II):ii14-7. DOI:10.1136/ARD.2004.032482
4. Wu D, Griffith JF, Lam SHM, et al. Progressive structural bone changes and their relationship with treatment in patients with psoriatic arthritis: a longitudinal HRpQCT study. Arthritis Res Ther. 2019;21:265. DOI:10.1186/s13075-019-2043-3
5. Geijer M, Lindqvist U, Husmark T, et al. The Swedish Early Psoriatic Arthritis Registry 5-year followup: substantial radiographic progression mainly in men with high disease activity and development of dactylitis. J Rheumatol. 2015;42:2110-7. DOI:10.3899/jrheum.150165
6. Stouten V, Pazmino S, Verschueren P, et al. Comorbidity burden in the first three years after diagnosis in patients with rheumatoid arthritis, psoriatic arthritis or spondyloarthritis: a general practice registry-based study. RMD Open. 2021;7:e001671. DOI:10.1136/RMDOPEN-2021-001671
7. Mease PJ, Palmer JB, Liu M, et al. Influence of axial involvement on clinical characteristics of psoriatic arthritis: analysis from the Corrona Psoriatic Arthritis/Spondyloarthritis Registry. J Rheumatol. 2018;45(10):1389-96. DOI:10.3899/ jrheum.171094
8. Schoels MM, Aletaha D, Alasti F, et al. Disease activity in psoriatic arthritis (PsA): defining remission and treatment success using the DAPSA score. Ann Rheum Dis. 2016;75(5):811-8. DOI:10.1136/annrheumdis-2015-207507
9. Chandran V, Tolusso DC, Cook RJ, et al. Risk factors for axial inflammatory arthritis in patients with psoriatic arthritis. J Rheumatol. 2010;37(4):809-15. DOI:10.3899/jrheum.091059
10. Haroon M, Winchester R, Giles JT. et al. Clinical and genetic associations of radiographic sacroiliitis and its different patterns in psoriatic arthritis. Clin Exp Rheumatol. 2017;35(2):270-6.
11. Gubar EE, Loginova EYu, Kоrsakova YuL, et al. Specific features of axial involvement in psoriatic arthritis: data from real clinical practice. Rheumatology Science and Practice. 2020;58(4):401-6 (in Russian). DOI:10.47360/1995-4484-2020-401-406
12. Gossec L, Baraliakos X, Kerschbaumer A, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis. 2020;79:700-12. DOI:10.1136/annrheumdis-2020-217159
13. Mease PJ, Karki C, Palmer JB, et al. Clinical Characteristics, Disease Activity, and Patient-Reported Outcomes in Psoriatic Arthritis Patients With Dactylitis or Enthesitis: Results From the Corrona Psoriatic Arthritis/Spondyloarthritis Registry. Arthritis Care Res. (Hoboken). 2017;69:1692-9. DOI:10.1002/ACR.23249
14. Loginova EYu, Korotaeva TV, Gubar EE, et al. Influence of the duration of psoriatic arthritis on the achievement of remission and minimal disease activity during therapy with genetically engineered biologic drugs. Data from the All-Russian register of patients with psoriatic arthritis. Rheumatology Science and Practice. 2020;58(6):695-700 (in Russian). DOI:10.47360/1995-4484-2020-695-700
15. Landewe R, Ritchlin CT, Aletaha D, et al. Inhibition of radiographic progression in psoriatic arthritis by adalimumab independent of the control of clinical disease activity. Rheumatology. 2019;58:1025-33. DOI:10.1093/rheumatology/key417
16. Klingberg E, Bilberg A, Björkman S, et al. Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study. Arthritis Res Ther. 2019;21(1):17. DOI:10.1186/s13075-019-1810-5
17. Smolen JS, Siebert S, Korotaeva TV, et al. Effectiveness of IL-12/23 inhibition (ustekinumab) versus tumour necrosis factor inhibition in psoriatic arthritis: observational PsABio study results. Ann Rheum Dis. 2021;80(11):1419-28. DOI:10.1136/annrheumdis-2021-220263
18. Korsakova YuL, Korotaeva TV, Loginova EIu, et al. The relationship between obesity, cardiometabolic disorders and disease activityin psoriatic arthritis patients: data from the Russian register. Terapevticheskii Arkhiv (Ter. Arkh.). 2021;93(5):573-80 (in Russian). DOI:10.26442/00403660.2021.05.200789
19. Haddad A, Saliba W, Lavi I, et al. The association of psoriatic arthritis with all-cause of mortality and leading causes of death in psoriatic arthritis. J Rheumatol. 2022;49(2):165-70. DOI:10.3899/JRHEUM.210159
20. Tekin HG, Wu JJ, Burge R, et al. Burden and Disease Characteristics of Patients with Psoriatic Arthritis: A Population-based Cross-sectional Study. J Rheumatol. 2019;46(7):716-20. DOI:10.3899/jrheum.180670
21. Gisondi P, Bellinato F, Targher G, et al. Biological disease-modifying antirheumatic drugs may mitigate the risk of psoriatic arthritis in patients with chronic plaque psoriasis. Ann Rheum Dis. 2022;81(1):68-73. DOI:10.1136/annrheumdis-2021-219961
22. Burgos-Pol R, Martinez-Sesmero JM, Ventura-Cerda JM, et al. The Cost of Psoriasis and Psoriatic Arthritis in 5 European Countries: A Systematic Review. Actas dermosifiliogr. 2016;107:577-90. DOI:10.1016/j.ad.2016.04.018
1 ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой», Москва, Россия;
2 ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России, Санкт-Петербург, Россия;
3 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*yulkorsakova@bk.ru
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Yulia L. Korsakova*1, Elena Yu. Loginova1, Tatiana V. Korotaeva1, Elena E. Gubar1, Svetlana I. Glukhova1, Elizaveta A. Vasilenko2, Evgeny L. Nasonov1,3
1 Nasonova Research Institute of Rheumatology, Moscow, Russia;
2 Mechnikov North-Western State Medical University, Saint Petersburg, Russia;
3 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*yulkorsakova@bk.ru