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Objective: to investigate the clinical and instrumental manifestations of axial psoriatic arthritis (axPsA) in combination with hyperuricemia (HU). Material and methods. The study included 71 patients with psoriatic arthritis (PsA): 59 (83%) men and 12 (17%) women. These patients had clinical and imaging evidence of inflammatory changes in the spine and were diagnosed with axPsA. The mean age of patients was 45.7±11.3 years, duration of psoriasis (Ps) was 209.3±163.4 months, and duration of PsA was 51.9±45.5 months. Patients underwent standard clinical, laboratory and radiological examinations. Patients completed the PsAID-12, FACIT-F and FiRST questionnaires and their LEI, MASES, DAPSA, BASDAI, BASFI, BASMI, ASDAS-CRP and BSA indices were assessed. Data on concomitant diseases and drug therapy were also collected. HU was diagnosed at uric acid (UA) level of >360 μmol/L. Patients were divided into two groups – with HU (group 1, n=24, 33.8%) and without HU (group 2, n=47, 66.2%). Results and discussion. The mean UA level was 329.96±80.2 μmol/l. The age of the patients, the duration of Ps and PsA were comparable in both groups. The activity of PsA and spondylitis in the two groups also did not differ. No significant differences were found between the groups in frequency of sacroiliitis or presence of erosions. In the 1st group, the total number of syndesmophytes in two sections of the spine was significantly higher (n=26, 108%) than in the 2nd group (n=39, 83%), p=0.04. In the group of patients with HU, there was a higher intensity of nocturnal spinal pain compared to the group without HU (5.0±2.7 and 3.6±2.8, respectively; p=0.04), more pronounced sleep disturbances (11±5.2 and 7±5.9; p=0.04), higher triglyceride levels (median 0.92 [0; 1.66] and 0.3 [0; 0.6]; p=0.03) and a higher frequency of hypertriglyceridemia (n=2, 8.3% and n=0; p=0.04) and liver steatosis (n=7, 29.1% and n=5, 10.6%; p=0.04, respectively). Patients with HU received antihypertensive therapy (n=10, 41.7% and n=14, 29.8% respectively; p=0.04) and urate-lowering medications (n=4, 16.6% and n=1, 2.1% respectively; p=0.02) significantly more often than patients without HU. Conclusion. HU was present in one third of patients with axPsA. They were more likely to have multiple syndesmophytes in the spine, metabolic disturbances, more severe nocturnal spinal pain and more pronounced sleep disturbances.
Objective: to investigate the clinical and instrumental manifestations of axial psoriatic arthritis (axPsA) in combination with hyperuricemia (HU). Material and methods. The study included 71 patients with psoriatic arthritis (PsA): 59 (83%) men and 12 (17%) women. These patients had clinical and imaging evidence of inflammatory changes in the spine and were diagnosed with axPsA. The mean age of patients was 45.7±11.3 years, duration of psoriasis (Ps) was 209.3±163.4 months, and duration of PsA was 51.9±45.5 months. Patients underwent standard clinical, laboratory and radiological examinations. Patients completed the PsAID-12, FACIT-F and FiRST questionnaires and their LEI, MASES, DAPSA, BASDAI, BASFI, BASMI, ASDAS-CRP and BSA indices were assessed. Data on concomitant diseases and drug therapy were also collected. HU was diagnosed at uric acid (UA) level of >360 μmol/L. Patients were divided into two groups – with HU (group 1, n=24, 33.8%) and without HU (group 2, n=47, 66.2%). Results and discussion. The mean UA level was 329.96±80.2 μmol/l. The age of the patients, the duration of Ps and PsA were comparable in both groups. The activity of PsA and spondylitis in the two groups also did not differ. No significant differences were found between the groups in frequency of sacroiliitis or presence of erosions. In the 1st group, the total number of syndesmophytes in two sections of the spine was significantly higher (n=26, 108%) than in the 2nd group (n=39, 83%), p=0.04. In the group of patients with HU, there was a higher intensity of nocturnal spinal pain compared to the group without HU (5.0±2.7 and 3.6±2.8, respectively; p=0.04), more pronounced sleep disturbances (11±5.2 and 7±5.9; p=0.04), higher triglyceride levels (median 0.92 [0; 1.66] and 0.3 [0; 0.6]; p=0.03) and a higher frequency of hypertriglyceridemia (n=2, 8.3% and n=0; p=0.04) and liver steatosis (n=7, 29.1% and n=5, 10.6%; p=0.04, respectively). Patients with HU received antihypertensive therapy (n=10, 41.7% and n=14, 29.8% respectively; p=0.04) and urate-lowering medications (n=4, 16.6% and n=1, 2.1% respectively; p=0.02) significantly more often than patients without HU. Conclusion. HU was present in one third of patients with axPsA. They were more likely to have multiple syndesmophytes in the spine, metabolic disturbances, more severe nocturnal spinal pain and more pronounced sleep disturbances.
Objective: a comparative evaluation of the effect of the interleukin-17A inhibitor (iIL) netakimab (NTK) and methotrexate (MTX) on laboratory markers of endothelial dysfunction in patients with psoriatic arthritis (PsA) in comparison with the dynamics of clinical efficacy indicators during 6 months of therapy.Material and methods. We performed a dynamic observation of 66 patients with PsA who were prescribed MTX and NTK for the first time. Thirty of them (group 1) received MTX 15 mg/week in the form of subcutaneous (s/c) injections in combination with folic acid 5 mg/week orally; 36 patients (group 2) received NTK as s/c injections at a dose of 120 mg at weeks 0, 1 and 2, and then once every 2 weeks until week 14, from week 14 – once every 4 weeks. The control group consisted of 20 substantially healthy individuals without skin diseases, rheumatic immune-inflammatory diseases of the musculoskeletal system and clinically significant diseases of the cardiovascular system. The clinical data were analyzed before, 3 and 6 months after the start of treatment. In all patients, the concentration of vascular endothelial growth factor (VEGF), endothelin 1 (En-1) and nitric oxide (NO) was analyzed before the start of treatment and at the end of the third month of treatment.Results and discussion. The concentration of laboratory markers for endothelial dysfunction was increased in patients with PsA compared to the control group: the median value of VEGF was 19.8 [4.5; 49.4] and 5.2 [0.5; 9.8] pg/ml (p=0.004), En-1 – 286.4 [154; 439] and 96.5 [32; 188] pg/ml (p=0.002), NO – 4.3 [2.1; 12.5] and 2.2 [0.2; 5.0] pg/ml (p=0.02), respectively. By the end of the 3rd month of therapy, a decrease in the concentration of indicators of endothelial dysfunction was observed. The dynamics of VEGF and En-1 concentrations was more pronounced in patients receiving NTK during the first 3 months of treatment than in patients receiving MTX treatment. The median decrease in VEGF concentration was 10.2 [8.4; 13.7] and 7.0 [5.6; 11.7] pg/ml (p=0.043), in En-1 – 184.6 [167; 202] and 112.7 [97; 136] pg/ml (p=0.008), respectively. A more significant decrease in LEI, PASI and NAPSI was achieved when NTK was used for 3 and 6 months compared to MTX therapy.Conclusion. The work demonstrated the ability of NTK, iIL17A, to reduce the initially elevated levels of laboratory markers of endothelial dysfunction.
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 47.412.7 yrs., duration of PsO 200.6158.9 mo., PsA 79.681.9 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 p0.05 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, BMI30 kg/m2, HAQ-DI1, PsAID-124, arterial hypertension, metabolic syndrome and overall comorbidity (p0.05). There were no significant differences between groups in PsO severity by BSA3%, PASI1, LEI1, TJC, SJC, dactylitis, ESR30 mm/h, CRP10 mg/l, DAPSA, diabetes mellitus, hyperlipidemia, coronary heart disease and liver damage (p0.05). 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.
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