mrjСовременная ревматологияModern Rheumatology Journal1996-70122310-158XIMA-PRESS, LLC10.14412/1996-7012-2023-4-50-56mrj-1459Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSКлинико-иммунологические особенности фенотипа системной красной волчанки в сочетании с синдромом ШегренаClinical and immunologic features of the phenotype of systemic lupus erythematosus combined with Sjögren's syndromehttps://orcid.org/0000-0002-5206-1732СоловьевС. К.SolovyevS. K.

Соловьев Сергей Константинович.

115522, Москва, Каширское шоссе, 34А

Sergei K. Solovyov.

34A, Kashirskoe Shosse, Moscow 115522

sksoloviev@mail.ruhttps://orcid.org/0000-0002-1663-7810АсееваЕ. А.AseevaE. A.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

https://orcid.org/0000-0003-3987-8112БарановА. А.BaranovA. A.

150000, Ярославль, ул. Революционная, 5

5, Revolytzionnaya Street, Yaroslavl 150000

https://orcid.org/0000-0002-6068-3080ЛилаА. М.LilaA. M.

Кафедра ревматологии ФГБОУ ДПО «РМАНПО» Минздрава России.

115522, Москва, Каширское шоссе, 34А; 125993, Москва, ул. Баррикадная, 2/1, стр.1

Department of Rheumatology Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia.

34A, Kashirskoe Shosse, Moscow 115522; 2/1, Barrikadnaya Street, Build. 1, Moscow 125993

https://orcid.org/0000-0002-4160-7218НикишинаН. Ю.NikishinaN. Yu.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

https://orcid.org/0000-0002-4285-0869ГлуховаС. И.GlukhovaS. I.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian FederationФГБОУ ВО «Ярославский государственный медицинский университет» Минздрава РоссииРоссияYaroslavl State Medical University, Ministry of Health of RussiaRussian FederationФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»; ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияV.A. Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuing Professional Education, Ministry of Health of RussiaRussian Federation2023200820231745056Copyright © Соловьев С.К., Асеева Е.А., Баранов А.А., Лила А.М., Никишина Н.Ю., Глухова С.И., 20232023Соловьев С.К., Асеева Е.А., Баранов А.А., Лила А.М., Никишина Н.Ю., Глухова С.И.Solovyev S.K., Aseeva E.A., Baranov A.A., Lila A.M., Nikishina N.Y., Glukhova S.I.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/1459

Проблема клинико-иммунологической гетерогенности системной красной волчанки (СКВ) представляется весьма актуальной, в частности сочетание СКВ и синдрома Шегрена (СШ) предопределяет более благоприятный прогноз и особенности терапии.

Цель исследования — охарактеризовать клинико-иммунологические особенности сочетания СКВ и СШ.

Материал и методы

Материал и методы. В ретроспективное исследование включено 44 больных СКВ с СШ и 356 пациентов с СКВ без СШ, госпитализированных в ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой» с 2013 по 2021 г. Две группы пациентов сравнивали по продолжительности жизни, клиническим проявлениям, лабораторным показателям и терапии.

Результаты и обсуждение

Результаты и обсуждение. Определены следующие фенотипические особенности клинико-иммунологического варианта СКВ с СШ: значимо большая продолжительность СКВ (р<0,01); более высокая частота полиартрита (р=0,01) и синдрома Рейно (р<0,003) в дебюте заболевания. При СКВ с СШ за время болезни чаще, чем при СКВ без СШ, выявлялись подострая кожная красная волчанка, синдром Рейно, поражение периферической нервной системы (сенсорная полиневропатия и дистальная сенсорно-моторная полинев-ропатия), р<0,0001. Среди лабораторных нарушений у больных СКВ с СШ в большем числе случаев наблюдались лейкопения (р<0,0001), антитела к SSA/Ro, SSB/La и ревматоидный фактор (р<0,0001). В группе СКВ с СШ преобладал хронический вариант течения СКВ по классификации В.А. Насоновой и отмечалась более низкая активность, не требующие проведения терапии высокими дозами глюкокортикоидов; в этой группе значимо чаще применялись ритуксимаб (р<0,01), циклофосфан и метотрексат.

Заключение

Заключение. Таким образом, установлены значимые клинико-лабораторные различия между СКВ с СШ и без СШ, наличие которых определяет прогноз, подходы к патогенетической терапии и мониторингу.

The problem of clinical and immunological heterogeneity of systemic lupus erythematosus (SLE) is of great interest, especially the combination of SLE and Sjögren's syndrome (SjS) determines a more favorable prognosis and specifics of therapy.

Objective

Objective: to characterize the clinical and immunological features of SLE combined with SjS.

Material and methods

Material and methods. The retrospective study included 44 patients with SLE combined with SjS and 356 patients with SLE without SjS, hospitalized at the V.A. Nasonova Research Institute of Rheumatology between 2013 and 2021. The two groups of patients were compared in terms of life expectancy, clinical manifestations, laboratory parameters and therapy.

Results and discussion

Results and discussion. The following phenotypic features of the clinical and immunological variant of SLE combined with SjS were found: significantly longer duration of SLE (p<0.01); higher incidence of polyarthritis (p=0.01) and Raynaud's syndrome (p<0.003) at disease onset. Subacute cutaneous lupus erythematosus, Raynaud's syndrome, peripheral nervous system involvement (sensory polyneuropathy and distal sensory-motor polyneuropathy) were found more frequently in SLE combined with SjS than in SLE without SjS, p<0.0001. Among laboratory abnormalities in SLE patients with SjS, leukopenia (p<0.0001), antibodies to SSA/Ro, SSB/La, and rheumatoid factor (p<0.0001) were observed in a greater number of cases. In the group of SLE combined with SjS, the chronic variant of SLE course according to the classification of V.A. Nasonova, and lower activity were observed, which didn't not require therapy with high doses of glucocorticoids; in this group, rituximab (p<0.01), cyclophosphamide and methotrexate were used significantly more often.

Conclusion

Conclusion. Thus, significant clinical and laboratory differences were found between SLE with SjS and without SjS. They determine prognosis, approaches to pathogenetic therapy and monitoring.

сочетание системной красной волчанки с синдромом Шегренаклинико-иммунологические особенностиcombination of systemic lupus erythematosus and Sjögrens syndromeclinical and immunological featuresСтатья подготовлена в рамках научно-исследовательской работы FURS-2022-003.The article was prepared as part of the research work FURS-2022-003.ReferencesAnaya JM, Rojas-Villarraga A, Mantilla RD, et al. Polyautoimmunity in Sjogren Syndrome. Rheum Dis Clin North Am. 2016 Aug;42(3): 457-72. doi: 10.1016/j.rdc.2016.03.005.Anaya JM, Rojas-Villarraga A, Mantilla RD, et al. Polyautoimmunity in Sjogren Syndrome. Rheum Dis Clin North Am. 2016 Aug;42(3): 457-72. doi: 10.1016/j.rdc.2016.03.005.Mavragani CP, Moutsopoulos NM, Moutsopoulos HM. The management of Sjogren's syndrome. Nat Clin Pract Rheumatol. 2006 May; 2(5):252-61. doi: 10.1038/ncprheum0165.Mavragani CP, Moutsopoulos NM, Moutsopoulos HM. The management of Sjogren's syndrome. 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The authors declare that there are no conflicts of interest present.