Цель -исследовать ассоциативную связь HLA-антигенов класса I с предрасположенностью к развитию псо-риатического артрита (ПсА), тяжестью течения и вариантами суставного синдрома при ПсА. Материал и методы. Включено 99 больных ПсА (56 женщин и 43 мужчины) в возрасте 43,5±13 лет и с медиа-ной длительности заболевания 2 [0,8; 10] года. Олигоартритический вариант наблюдался у 28 больных, по-лиартритический -у 39, дистальный -у 22, спондилоартритический -у 10. Сформированы две группы больных в зависимости от возраста возникновения псориаза: до 40 лет (n=71) и после 40 лет (n=23). Результаты. У больных ПсА по сравнению с контрольной группой было выявлено повышение частоты HLA-В13 (отношение шансов [ОШ] 2,72; p<0,004), В16 (ОШ 3,95; p<0,0001) и В27 (ОШ 3,2; p<0,003). Выявлена ассоциация вариантов поражения суставов с HLA-антигенами: дистального -с В13 (ОШ 3,38; p<0,02) и В16 (ОШ 3,95; p<0,01), полиартритического -с В16 (ОШ 5,90; p<0,0001) и В27 (ОШ 3,26; p<0,01), спондилоар-тритического -с В27 (ОШ 6,32; p<0,001). Дебют псориаза в молодом возрасте был ассоциирован с HLA-B13 (ОШ 3,29; p<0,001). Частота выявления антигена В38 (субтип HLA-В16) была повышена при всех рентгено-логических стадиях ПсА и составляла при I-IIА стадии 16,4%, при IIБ стадии -25%, при III-IV стадии -40,9% по сравнению с 8,7% в группе контроля, при этом сила ассоциативной связи увеличивалась с увеличе-нием степени выраженности деструкции в суставах. Заключение. Детальный анализ проведенного исследования выявил различное участие антигенов системы HLA в развитии ПсА и формировании клинических вариантов суставного синдрома. Objective: to investigate the association of HLA Class I antigens with the predisposition to psoriatic arthritis (PsA) and the severity and types of articular syndrome in PsA. Subjects and methods. The investigation enrolled 99 patients (56 females and 43 males) aged 43.5±13 years with PA with a median duration of 2 (range 0.8-10) years. An oligoarthritic type was observed in 28 patients, polyarthritic, distal, and spondyloarthritic types were present in 28, 39, and 10 patients, respectively. Two patient groups were formed according to the age at onset of psoriasis: 1) 71 patients aged less than 40 years and 2) 23 patients aged over 40 years.Results. As compared with the control group, the patients with PsA were found to have a higher frequency of HLA-B13 (odds ratio [OR] 2.72; p < 0.004), HLA-В16 (OR 3.95; p < 0.0001), and HLA-В27 (OR 3.2; p < 0.003). There was an association of the types of joint injury with HLA antigens: the distal type with HLA-B13 (OR 3.38; p < 0.02) and HLA-В16 (OR 3.95; p < 0.01), the polyarthritic type with HLA-В16 (OR 5.90; p < 0.0001) and HLA-В27 (OR 3.26; p < 0.01), and the spondyloarthritic type with HLA-В27 (OR 6.32; p < 0.001). The young onset of psoriasis was associated with HLA-B13 (OR 3.29; p < 0.001). The detection rate of the B38 antigen (the subtype of HLA-B16) was higher in all X-ray stages of PsA and was 16.4% in Stages I-IIA, 25% in Stage IIB, and 40.9% in Stages III-IV versus 8.7% in the contr...

Цель исследования -выявить характерные симптомы и синдромы ранней стадии псориатического артрита (рПсА)

Background Enthesitis are characteristic for psoriatic arthritis (PsA) and can be manifestations of the early stage of this disease. Objectives To investigate the presence of lower limbs entheseal abnormalities and to determine clinical significant of enthesitis in early PsA. Methods 51 patients (28 women, 23 men) with early PsA (mean age 43±13.8 yrs; disease duration 11.5±6.9 months; psoriasis duration was 11 yrs) were enrolled. All patients were tested to determined of dactylitis and psoriatic onychodystrophy, clinical assessment of swollen and tender Achilles tendon and planter aponeurosis, disease activity index (DAS28), C-reactive protein by highly sensitive method (hsCRP). Radiographs of the hands and feet were observed using the Sharp’s method modified by van der Heijde including distal interphalangeal joints. All patients were underwent ultrasonography (US) by the apparatus Voluson-I (GE) using a 4-13 MHz linear-array transducer. The reduced index GUESS was applied for score of enthesitis: Achilles tendon thickness >5.29 mm, retrocalcaneal bursitis, posterior pole of calcaneus erosion, posterior pole of calcaneus enthesophyte, plantar aponeurosis thickness >4.4 mm, inferior pole of calcaneus erosion, inferior pole of calcaneus enthesophyte. Total possible score on belateral lower limb is 14. Results On clinical examination 16 (31.4%) entheseal sites were abnormal and on US examination 35 (68.6%) sites were abnormal, (p=0.0002). Achilles tendon thickness was found in 15 (29.4%) patients with early PsA, retrocalcaneal bursitis – in 4 (7.8%), plantar aponeurosis thickness – in 27 (53%), calcaneus erosion – in 3 (6%), calcaneus enthesophyte – in 20 (39.2%). The dactylitis were detected in 25 (49%) patients and psoriatic onychodystrophy – in 27 (53%). Median DAS28 index was 4.8 [3.3; 5.6], median hsCRP - 9.3 [2.1; 28], mean Sharp’s index - 32±5.0. Index GUESS of patients was from 1 to 6 point (mean 2.4±0.2). There was significant correlation between the index GUESS and high degree of the disease activity - DAS28 (r=0.49, p=0.0001), hsCRP (r=0.43, p=0.001), dactylitis (r=0.32, p=0.02), index Sharp (r=0.30, p=0.03) and onychodystrophy (r=0.34, p=0.01). Conclusions The enthesitis as characteristic symptom of PsA were found the early stage of the disease in high percentage. They associated with higher degree of inflammatory activity of the disease, dactylitis, psoriatic onychodystrophy and with higher incidence of erosive disease. This study has shown the US may be useful in the detection of entheseal abnormality in early PsA patients than clinical examination. Disclosure of Interest None Declared

6±4 and 10±1.5, respectively (p = 0.04); that of swollen ones, 12.6±1.5 and 7.0±1.1 (p = 0.02); DAS28 index, 5.9±1.7 and 4.5±1.5 (p = 0.02); ESR, 34.5±5.9 and 22±2.3 (p = 0.04), 70±25.3 and 24.9±5.0 (p = 0.06); and Sharp ratio, 68.7±14.3 and 21.3±3.8 (p < 0.004). Conclusion. In patients with early PA, anti-CCP and RF were encountered with an approximately equal frequency; at the same time, they were associated with polyarthritis, high disease activity, and an erosive process.

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