mrjСовременная ревматологияModern Rheumatology Journal1996-70122310-158XIMA-PRESS, LLC10.14412/1996-7012-2020-3-125-131mrj-1049Research ArticleОБЗОРЫREVIEWSHLA-В27-ассоциированный увеит: самостоятельная болезнь или вариант спондилоартрита?HLA-B27-associated uveitis: an independent disease or a variant of spondyloarthritis?ГодзенкоА. А.GodzenkoA. A.

Алла Александровна Годзенко

Кафедра ревматологии

125993, Москва, ул. Баррикадная, 2/1, стр. 1

 

Alla Aleksandrovna Godzenko

Department of Rheumatology

2/1, Barrikadnaya St., Build. 1, Moscow 125993

alla1106@mail.ruРазумоваИ. Ю.RazumovaI. Yu.

119021, ул. Россолимо, 11А

11A, Rossolimo St., Moscow 119021

ГусеваИ. А.GusevaI. A.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияRussian Medical Academy of Continuing Professional Education, Ministry of Health of RussiaRussian FederationФГБНУ «Научно-исследовательский институт глазных болезней»РоссияResearch Institute of Eye DiseasesRussian FederationФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation202021092020143125131Copyright © Годзенко А.А., Разумова И.Ю., Гусева И.А., 20202020Годзенко А.А., Разумова И.Ю., Гусева И.А.Godzenko A.A., Razumova I.Y., Guseva I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://mrj.ima-press.net/mrj/article/view/1049

В статье освещены вопросы взаимосвязи HLA-В27-ассоциированного увеита и спондилоартритов (СпА). Представлены генетические аспекты воспаления глаз и опорно-двигательного аппарата, роль антигена гистосовместимости HLA-В27 и вклад других генов в развитие увеита и спондилита. Охарактеризованы общие патогенетические механизмы развития этих заболеваний: значение факторов врожденного иммунитета, провоспалительных цитокинов в инициации воспаления глаз и суставов. Проанализирована частота выявления СпА при разных формах увеита, выявлены предикторы развития СпА у пациентов с увеитом. Представлен алгоритм, позволяющий своевременно диагностировать СпА при наличии острого переднего увеита. В качестве наиболее значимых признаков, ассоциированных со СпА у пациентов с увеитом, выделены HLA-В27, локализация воспаления в переднем отрезке глаза, одностороннее поочередное поражение глаз, острое рецидивирующее течение, дебют увеита в возрасте до 30 лет. Сопоставлены особенности течения и частота осложнений при увеите со СпА и без СпА. Показано, что при наличии СпА статистически значимо чаще возникают обострения увеита и связанные с ним осложнения. Обоснована необходимость тесного взаимодействия офтальмологов и ревматологов в процессе ведения пациентов с увеитом.

The paper highlights the relationship between HLA-B27-associated uveitis and spondyloarthritis (SpA). It presents the genetic aspects of inflammation of the eyes and musculoskeletal system, the role of the HLA-B27 histocompatibility antigen, and the contribution of other genes to the development of uveitis and spondylitis. The authors characterize the general pathogenetic mechanisms of the development of these diseases: the importance of factors of innate immunity, proinflammatory cytokines in the initiation of inflammation of the eyes and joints. The detection rate of SpA is analyzed in various forms of uveitis; the predictors of SpA development are identified in the patients. An algorithm is presented, which makes it possible to timely diagnose SpA in the presence of acute anterior uveitis. HLA-B27, inflammation in the ocular anterior chamber, unilateral alternating eye lesions, an acute recurrent course, and uveitis onset at the age of less than 30 years are singled out as the most significant signs associated with SpA in patients with uveitis. The features of the course and the frequency of complications in uveitis with and without SpA are compared. It is shown that exacerbations of uveitis and associated complications occur statistically significantly more frequently in SpA. There is evidence for the need for a close interaction between ophthalmologists and rheumatologists in the management of patients with uveitis.

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The authors declare that there are no conflicts of interest present.