mrjСовременная ревматологияModern Rheumatology Journal1996-70122310-158XIMA-PRESS, LLC10.14412/1996-7012-2026-1-36-43mrj-1904Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSВзаимосвязь трудоспособности и активности заболевания у пациентов с аксиальным псориатическим артритомAssociation between an ability to work and disease activity in patients with axial psoriatic arthritishttps://orcid.org/0000-0001-8626-8419ВоробьеваЛ. Д.VorobyovaL. D.

Любовь Дмитриевна Воробьева

Россия, 115522, Москва, Каширское шоссе, 34А 

Lyubov Dmitrievna Vorobyeva

34A, Kashirskoe Shosse, Moscow 115522, Russia

Evagolland@gmail.comhttps://orcid.org/0000-0003-0579-1131КоротаеваТ. В.KorotaevaT. V.

Россия, 115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522, Russia

https://orcid.org/0000-0001-6875-4552ЛогиноваЕ. Ю.LoginovaE. Yu.

Россия, 115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522, Russia

https://orcid.org/0000-0001-5968-2403КорсаковаЮ. Л.KorsakovaYu. L.

Россия, 115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522, Russia

https://orcid.org/0000-0001-5015-7143ГубарьЕ. Е.GubarE. E.

Россия, 115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522, Russia

https://orcid.org/0000-0003-4005-1745ТремаскинаП. О.TremaskinaP. O.

Россия, 115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522, Russia

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation2026190220262013643Copyright © Воробьева Л.Д., Коротаева Т.В., Логинова Е.Ю., Корсакова Ю.Л., Губарь Е.Е., Тремаскина П.О., 20262026Воробьева Л.Д., Коротаева Т.В., Логинова Е.Ю., Корсакова Ю.Л., Губарь Е.Е., Тремаскина П.О.Vorobyova L.D., Korotaeva T.V., Loginova E.Y., Korsakova Y.L., Gubar E.E., Tremaskina P.O.This work is licensed under a Creative Commons Attribution 4.0 License.https://mrj.ima-press.net/mrj/article/view/1904

Цель исследования – оценить взаимосвязь трудоспособности и активности заболевания у пациентов с псориатическим артритом (ПсА) в сочетании с поражением позвоночника.Материал и методы. В исследование включено 114 больных ПсА (50,8% мужчин и 49,2% женщин), соответствовавших критериям CASPAR 2006 г., с поражением позвоночника, подтвержденным визуализацией аксиальных структур (синдесмофиты, и/или рентгенологически достоверный сакроилиит – СИ, – и/или активный СИ по данным магнитно-резонансной томографии). Средний возраст пациентов составлял 46,1±11,6 года, длительность ПсА –48,6±41,5 мес, псориаза – 197,9±159,7 мес, хронической боли в спине – 67,5±63 мес. Всем пациентам проводили стандартное ревматологическое обследование, включавшее определение числа болезненных и припухших суставов (соответственно ЧБС/68 и ЧПС/66), оценку состояния здоровья врачом/пациентом (ОСЗВ/ОСЗП) и оценк у интенсивности боли по визуальной аналоговой шкале, ночной боли в спине (НБС) по числовой рейтинговой шкале, уровня СРБ в крови, индексов активности BASDAI, DAPSA и ASDAS. Трудоспособность определяли по опроснику WPAI-SHP по шкалам абсентеизма, презентеизма, общего снижения производительности (ОСП) труда и снижения повседневной активности (CПА). Дополнительно оценивали количество пациентов (в %) с суммарным снижением трудоспособности по всем шкалам >50% (ССТ50).Результаты и обсуждение. Абсентеизм, презентеизм, ОСП и СПА выявлены у 44,6; 49,7; 55,6 и 43,1% обследованных соответственно. ССТ50 отмечено у 57,8% (у 66 из 114) больных. Обнаружена значимая прямая корреляция нарушения трудоспособности по всем шкалам WPAI (p<0,05) с женским полом и активностью ПсА: ЧПС66 >5, DAPSA ≥14, ASDAS ≥2,1 и BASDAI ≥4. Были определены факторы, способствующие ССТ50: наличие ≥1 энтезита (отношение шансов, ОШ 1,72; 95% доверительный интервал, ДИ 0,745–3,714), DAPSA ≥14 (ОШ 1,814; 95% ДИ 0,486–6,158), ASDAS ≥2,1 (ОШ 1,296; 95% ДИ 0,6877–2,444), для всех случаев p<0,05. У пациентов с высокой активностью по ASDAS отмечалось нарушение по всем шкалам опросника WPAI, кроме ОСП. Активность по DAPSA влияла на абсентеизм (р=0,04) и СПА (р=0,01). Высокая активность по BASDAI статистически значимо ухудшала все показатели опросника WPAI. Отдельно были выявлены факторы, которые ассоциировались с нарушением трудоспособности и высокой активностью по ASDAS: воспалительная боль в спине (ВБС; ОШ 5,285; 95% ДИ 0,373–6,836), энтезиты по индексу LEI ≥1 (ОШ 2,268; 95% ДИ 0,479–10,733), ЧПС >5 (ОШ 1,037; 95% ДИ 0,243–4,418). Нарушение трудоспособности при высокой активности по DAPSA было связано с такими значимыми факторами, как ЧПС >5 (ОШ 1,145; 95% ДИ 0,27–4,85), ЧБС >5 (ОШ 1,789; 95% ДИ 0,405–7,905), наличие энтезитов по LEI ≥1 (ОШ 2,683; 95% ДИ 0,633–11,377), СРБ >5 мг/л (ОШ 1,007; 95% ДИ 0,978–1,036). С нарушением трудоспособности и высокой активностью по BASDAI ассоциировались ЧБС >5 (ОШ 1,489; 95% ДИ 0,322–6,895), наличие энтезитов по LEI ≥1 (ОШ 2,33; 95% ДИ 0,524–10,363), ВБС (ОШ 20,11; 95% ДИ 11,128–36,45), НБС (ОШ 1,435; 95% ДИ 0,344–5,984).Заключение. У половины больных ПсА с поражением позвоночника, преимущественно женщин, выявлено снижение трудоспособности по шкалам абсентеизма, презентеизма, ОСП, СПА, которое ассоциировалось с высокой активностью спондилита и периферического артрита. Применение генно-инженерных биологических препаратов позволяет снизить активность ПсА и улучшить трудоспособность больных, что может иметь большое социально-экономическое значение.

Objective: to assess the association between an ability to work (AW) and disease activity in patients with psoriatic arthritis (PsA) combined with spinal involvement.Material and methods. The study included 114 patients with PsA (50.8% men and 49.2% women) who met the 2006 CASPAR criteria (ClASsification criteria for Psoriatic ARthritis) and had spinal involvement confirmed by imaging of axial structures (syndesmophytes and/or radiographically definite sacroiliitis (SI) and/or active SI on magnetic resonance imaging). The mean age of the patients was 46.1±11.6 years; PsA duration was 48.6±41.5 months, psoriasis duration – 197.9±159.7 months, and chronic back pain duration – 67.5±63 months. All patients underwent a standard rheumatologic assessment, including tender and swollen joint counts (TJC/68 and SJC/66, respectively), physician/patient global assessment of health (PhGA/PtGA), and assessment of pain intensity using a visual analog scale; night back pain (NBP) using a numeric rating scale; blood CRP level; and the activity indices BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), DAPSA (Disease Activity in Psoriatic Arthritis), and ASDAS (Ankylosing Spondylitis Disease Activity Score). AW was assessed using the WPAI-SHP (Work Productivity and Activity Impairment; Specific Heath Problem) questionnaire on the scales of absenteeism, presenteeism, overall work productivity loss (OWPL), and activity impairment (AI). Additionally, the proportion of patients (%) with an overall reduction in AW across all scales >50% (ORAW50) was evaluated.Results and discussion. Absenteeism, presenteeism, OWPL, and AI were identified in 44.6%, 49.7%, 55.6%, and 43.1% of patients, respectively. ORAW50 was observed in 57.8% (66 of 114) of patients. A significant positive correlation was found between impaired AW across all WPAI scales (p<0.05) and female sex and PsA activity: SJC66 >5, DAPSA ≥14, ASDAS ≥2.1, and BASDAI ≥4. Factors contributing to ORAW50 were identified: presence of ≥1 enthesitis (odds ratio (OR) 1.72; 95% confidence interval (CI) 0.745–3.714), DAPSA ≥14 (OR 1.814; 95% CI 0.486–6.158), ASDAS ≥2.1 (OR 1.296; 95% CI 0.6877–2.444), for all cases p<0.05. In patients with high ASDAS activity, impairment was noted on all WPAI scales except OWPL. DAPSA activity affected absenteeism (p=0.04) and AI (p=0.01). High BASDAI activity statistically significantly worsened all WPAI outcomes. Separately, factors associated with impaired AW and high ASDAS activity were identified: inflammatory back pain (IBP; OR 5.285; 95% CI 0.373–6.836), enthesitis by the LEI index ≥1 (OR 2.268; 95% CI 0.479–10.733), and SJC >5 (OR 1.037; 95% CI 0.243–4.418). Impaired AW with high DAPSA activity was associated with significant factors such as SJC >5 (OR 1.145; 95% CI 0.27–4.85), TJC >5 (OR 1.789; 95% CI 0.405–7.905), presence of enthesitis by LEI ≥1 (OR 2.683; 95% CI 0.633–11.377), and CRP >5 mg/L (OR 1.007; 95% CI 0.978–1.036). Impaired AW and high BASDAI activity were associated with TJC >5 (OR 1.489; 95% CI 0.322–6.895), presence of enthesitis by LEI ≥1 (OR 2.33; 95% CI 0.524–10.363), IBP (OR 20.11; 95% CI 11.128–36.45), and NBP (OR 1.435; 95% CI 0.344–5.984).Conclusion. In half of patients with PsA and spinal involvement, predominantly women, reduced AW was found on the absenteeism, presenteeism, OWPL, and AI scales, which was associated with high activity of spondylitis and peripheral arthritis. The use of biologic disease-modifying agents makes it possible to reduce PsA activity and improve patients’ AW, which may have major socio-economic significance.

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