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Современная ревматология

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К вопросу и н терстициального поражения легких при ревматоидном артрите

https://doi.org/10.14412/1996-7012-2014-4-48-53

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Аннотация

Ревматоидный артрит (РА) – системное аутоиммунное ревматическое заболевание неизвестной этиологии, для которого характерны хронический эрозивный артрит и внесуставные проявления. Поражение легких является одним из частых внесуставных проявлений РА и может проявляться патологией бронхиального дерева, ревматоидными узелками, синдромом Каплана, поражением плевры, интерстиция легких (интерстициальное поражение легких – ИПЛ). Использование компьютерной томографии высокого разрешения позволяет диагностировать ИПЛ при РА примерно в 70% случаев, хотя частота ИПЛ может быть ниже (от 4 до 30%) в зависимости от методов диагностики, критериев отбора больных. Существует несколько гистопатологических вариантов ИПЛ, дифференциальная диагностика которых может вызывать затруднения. Обычная интерстициальная пневмония (ОИП) и неспецифическая интерстициальная пневмония являются основными вариантами ИПЛ, ассоциированного с РА. ИПЛ с картиной ОИП имеет более тяжелое течение, чем ИПЛ с другими гистологическими вариантами. Картина ИПЛ может осложняться вероятным токсическим эффектом ряда базисных противовоспалительных препаратов (БПВП), применяемых для лечения РА, например метотрексата и лефлуномида, и генно-инженерных биологических препаратов (ГИБП) – ингибиторов фактора некроза опухоли (ФНО) α. Необходимо дальнейшее исследование патогенеза поражения легких при РА, роли синтетических БПВП и ГИБП в развитии ИПЛ. Присутствие такого внесуставного проявления, как ИПЛ, влияет на выбор терапевтической тактики у больных РА.

Актуальность изучения ИПЛ при РА не вызывает сомнений. В статье обсуждается современное состояние исследований в данной области.

Об авторах

Давид Владимирович Бестаев
ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»
Россия

115522, Россия, Москва, Каширское шоссе, д. 34А



Т. Д. Бестаева
ГБОУ ВПО «Северо-Осетинская государственная медицинская академия» Минздрава России
Россия

362019, Россия, Республика Северная Осетия-Алания, Владикавказ, ул. Пушкинская, 40



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Для цитирования:


Бестаев Д.В., Бестаева Т.Д. К вопросу и н терстициального поражения легких при ревматоидном артрите. Современная ревматология. 2014;8(4):48-53. https://doi.org/10.14412/1996-7012-2014-4-48-53

For citation:


Bestaev D.V., Bestaeva T.D. Interstitial lung involvement in rheumatoid arthritis. Modern Rheumatology Journal. 2014;8(4):48-53. (In Russ.) https://doi.org/10.14412/1996-7012-2014-4-48-53

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