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Энтезит – ключ к диагнозу спондилоартрита, акцент на псориатический артрит

https://doi.org/10.14412/1996-7012-2020-3-79-86

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Аннотация

Энтезит – характерный клинический признак спондилоартритов (СпА), который проявляется воспалением мест прикрепления сухожилия или связки к кости или суставной капсуле. Важность выявления энтезита для диагностики СпА подтверждается включением его в классификационные критерии псориатического артрита (ПсА) – CASPAR – и в классификационные критерии СпА Международной группы по изучению спондилоартритов – ASAS. Энтезит может быть первым клиническим признаком дебюта СпА, а также ведущим симптомом, существенно влияющим на выбор тактики терапии. Энтезит встречается у 30–50% пациентов со СпА и ассоциируется с высокой активностью заболевания, большей выраженностью боли и худшим качеством жизни. Частота энтезита, выявляемого при УЗИ, у пациентов с ПсА приблизительно в 4 раза выше, чем у пациентов с анкилозирующим спондилитом, и взаимосвязана с тяжестью заболевания. В представленном обзоре литературы рассмотрены современные данные, касающиеся патофизиологии, диагностики и лечения энтезита. Недавние исследования подчеркивают необходимость использования для диагностики энтезита визуализационных методов исследования, так как они обладают более высокой чувствительностью и специфичностью по сравнению с результатами клинического обследования. Данные о влиянии синтетических базисных противовоспалительных препаратов на энтезит весьма малочисленны, тогда как таргетные и генно-инженерные биологические препараты показали высокую эффективность в его лечении по сравнению с плацебо. Предварительные данные свидетельствуют о том, что для подавления воспаления в энтезисах воздействие на интерлейкин (ИЛ) 17 или ИЛ12/23 может быть более эффективным, чем на фактор некроза опухоли α.

Об авторах

Е. Д. Егудина
Клиника современной ревматологии
Украина

Елизавета Давидовна Егудина

08700, Киев, ул. Днепровская набережная, 25



С. А. Триполка
Коммунальное некоммерческое предприятие Харьковского областного совета «Областная клиническая больница»
Украина

61000, Харьков, проспект Независимости, 13



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Для цитирования:


Егудина Е.Д., Триполка С.А. Энтезит – ключ к диагнозу спондилоартрита, акцент на псориатический артрит. Современная ревматология. 2021;15(1):79-86. https://doi.org/10.14412/1996-7012-2020-3-79-86

For citation:


Yehudina Y.D., Trypolka S.A. Enthesitis is a clue to the diagnosis of spondyloarthritis, focus on psoriatic arthritis. Modern Rheumatology Journal. 2021;15(1):79-86. (In Russ.) https://doi.org/10.14412/1996-7012-2020-3-79-86

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ISSN 1996-7012 (Print)
ISSN 2310-158X (Online)