mrjСовременная ревматологияModern Rheumatology Journal1996-70122310-158XIMA-PRESS, LLC10.14412/1996-7012-2026-2-61-67mrj-1958Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSПоиск значимых клинико-визуализационных критериев для дифференциальной диагностики аксиального спондилоартрита и аксиального псориатического артритаSearch for significant clinical and imaging criteria for the differential diagnosis of axial spondyloarthritis and axial psoriatic arthritishttps://orcid.org/0000-0001-5015-7143ГубарьЕ. Е.GubarE. E.

Елена Ефимовна Губарь 

115522, Москва, Каширское шоссе, 34А 

Elena Efimovna Gubar 

34A, Kashirskoe Shosse, Moscow 115522 

gubarelena@yandex.ruhttps://orcid.org/0000-0003-0579-1131КоротаеваТ. В.KorotaevaT. V.

115522, Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522 

https://orcid.org/0000-0002-1771-6246ДубининаТ. В.DubininaT. V.

115522, Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522 

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

115522, Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522 

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

115522, Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522 

https://orcid.org/0000-0001-8626-8419ВоробьеваЛ. Д.VorobyevaL. D.

115522, Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522 

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

115522, Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522 

https://orcid.org/0000-0002-2246-686XАгафоноваЕ. М.AgafonovaE. M.

115522, Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522 

https://orcid.org/0000-0003-2486-8798СахароваК. В.SakharovaK. V.

115522, Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522 

https://orcid.org/0000-0002-3106-3296АндриановаИ. А.AndrianovaI. A.

115522, Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522 

https://orcid.org/0000-0001-7418-9369СмирновА. В.SmirnovA. V.

115522, Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522 

https://orcid.org/0000-0003-3195-5187ЭрдесШ. Ф.ErdesSh. F.

115522, Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522 

https://orcid.org/0000-0002-9755-5760УрумоваМ. М.UrumovaM. M.

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 Federation2026220420262026167Copyright © Губарь Е.Е., Коротаева Т.В., Дубинина Т.В., Корсакова Ю.Л., Логинова Е.Ю., Воробьева Л.Д., Тремаскина П.О., Агафонова Е.М., Сахарова К.В., Андрианова И.А., Смирнов А.В., Эрдес Ш.Ф., Урумова М.М., Глухова С.И., 20262026Губарь Е.Е., Коротаева Т.В., Дубинина Т.В., Корсакова Ю.Л., Логинова Е.Ю., Воробьева Л.Д., Тремаскина П.О., Агафонова Е.М., Сахарова К.В., Андрианова И.А., Смирнов А.В., Эрдес Ш.Ф., Урумова М.М., Глухова С.И.Gubar E.E., Korotaeva T.V., Dubinina T.V., Korsakova Y.L., Loginova E.Y., Vorobyeva L.D., Tremaskina P.O., Agafonova E.M., Sakharova K.V., Andrianova I.A., Smirnov A.V., Erdes S.F., Urumova M.M., 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/1958

Цель исследования – определение набора критериев для дифференциальной диагностики аксиального спондилоартрита (аксСпА) и аксиального псориатического артрита (аксПсА).

Материал и методы

Материал и методы. Обследовано 222 больных: 108 – аксСпА (1-я группа) и 114 – аксПсА (2-я группа). В 1-ю группу включены пациенты, соответствовавшие критериям аксСпА, во 2-ю группу – пациенты с ПсА, имевшие аксиальное поражение и отвечавшие критериям CASPAR. Аксиальное поражение диагностировали при наличии рентгенологически достоверного (рд) сакроилиита (СИ), т. е. двустороннего СИ ≥II стадии либо одностороннего ≥III стадии, или активного СИ по данным магнитно-резонансной томографии, или при наличии ≥1 синдесмофита в шейном (ШОП) и/или поясничном отделе позвоночника. Определяли воспалительную боль в спине (ВБС) по критериям ASAS. Проводили рентгенографию кистей и стоп. Использовали метод многомерного анализа – построение деревьев классификации.

Результаты и обсуждение

Результаты и обсуждение. Для больных аксПсА характерно начало боли в спине в возрасте старше 45 лет, наличие полиартрита с числом болезненных суставов >5 и числом припухших суставов >3, дактилита, псориаза кожи и ногтей, остеолиза, анкилоза суставов, внесуставных костных пролифераций, множественных эрозий. Отличительной чертой являются синдесмофиты в ШОП, асимметричные, несмыкающиеся, объемные синдесмофиты, изменения в позвоночнике при отсутствии СИ, наличие рдСИ, сформировавшегося без ВБС. Для пациентов с аксСпА характерен молодой возраст (<40 лет) на момент установления диагноза, наличие ВБС, поражение позвоночника без периферического артрита, наличие пяточного энтезита, увеита, воспалительного заболевания кишечника, семейного анамнеза по СпА, носительство HLA-B27, наличие рдСИ и анкилоза крестцово-подвздошных суставов.

Заключение

Заключение. Построение деревьев классификации позволило определить, что в основе дифференциального диагноза лежат такие признаки, как наличие или отсутствие псориаза в сочетании с периферической симптоматикой (припухлость суставов, интенсивные артралгии) и рентгенологическими признаками остеолиза.

Objective

Objective: to identify a set of criteria for the differential diagnosis of axial spondyloarthritis (axSpA) and axial psoriatic arthritis (axPsA).

Material and methods

Material and methods. A total of 222 patients were examined: 108 with axSpA (Group 1) and 114 with axPsA (Group 2). Group 1 included patients meeting the axSpA criteria; Group 2 included patients with PsA who had axial involvement and met the CASPAR criteria. Axial involvement was diagnosed in the presence of radiographically definite (rd) sacroiliitis (SI), i.e., bilateral SI grade ≥II or unilateral SI grade ≥III, or active SI on magnetic resonance imaging, or ≥1 syndesmophyte in the cervical spine (C-spine) and/or lumbar spine. Inflammatory back pain (IBP) was defined according to the ASAS criteria. Radiographs of the hands and feet were performed. A multivariate analysis method was used (classification tree construction).

Results and discussion

Results and discussion. Patients with axPsA were characterized by onset of back pain after the age of 45 years, the presence of polyarthritis with a tender joint count >5 and a swollen joint count >3, dactylitis, skin and nail psoriasis, osteolysis, joint ankylosis, extra-articular bone proliferation, and multiple erosions. Distinctive features included syndesmophytes in the cervical spine, asymmetric, non-bridging, bulky syndesmophytes, spinal changes in the absence of SI, and the presence of rdSI that developed without IBP. Patients with axSpA were characterized by a younger age (<40 years) at diagnosis, presence of IBP, spinal involvement without peripheral arthritis, heel enthesitis, uveitis, inflammatory bowel disease, family history of SpA, HLA-B27 positivity, and the presence of rdSI and sacroiliac joint ankylosis.

Conclusion

Conclusion. Classification tree construction made it possible to determine that the differential diagnosis is based on features such as the presence or absence of psoriasis in combination with peripheral symptoms (joint swelling, severe arthralgia) and radiographic signs of osteolysis.

аксиальный спондилоартритаксиальный псориатический артритдифференциальная диагностикаклиниковизуализационные критерииaxial spondyloarthritisaxial psoriatic arthritisdifferential diagnosisclinical and imaging criteriaСтатья подготовлена в рамках фундаментальной научной темы № РК 125020501435-8 «Эволюция аксиальных спондилоартритов на основе комплексного динамического изучения молекулярно-биологических, молекулярно-генетических, клинико-визуализационных факторов прогрессирования заболевания, качества жизни, коморбидности и таргетной инновационной терапии».The article was prepared within the framework of the fundamental research project № RK 125020501435-8 “Evolution of axial spondyloarthritis based on a comprehensive dynamic study of molecular-biological, molecular-genetic, clinical and imaging factors of disease progression, quality of life, comorbidity, and targeted innovative therapy”.ReferencesNavarro-Compan, V, Sepriano A, Capelusnik D, Baraliakos X. Axial spondyloarthritis. 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The authors declare that there are no conflicts of interest present.