Поражение суставов и позвоночника у б ольных с воспалительными заболеваниями кишечника

Представлен обзор литературы, посвященной поражению опорно-двигательного аппарата при воспалительных заболеваниях кишечника (ВЗК). Описаны варианты поражения суставов и позвоночника при язвенном колите (ЯК) и болезни Крона (БК). Дана оценка соотношения дебюта и активности ВЗК и суставного синдрома. Наиболее частым вариантом суставного синдрома оказался периферический артрит, протекавший с вовлечением преимущественно коленных и голеностопных суставов, в большинстве случаев связанный с активностью ВЗК. В отличие от периферического артрита течение аксиального спондилоартрита, представленного изолированным сакроилиитом и анкилозирующим спондилитом (АС), не зависело от активности ВЗК. Приведены данные об изолированном сакроилиите, который нередко протекает бессимптомно, поздно диагностируется и у ряда больных является находкой при обследовании. Дана клинико-инструментальная характеристика АС при ВЗК, отмечена схожесть клинических проявлений и рентгенологических изменений с таковыми при идиопатическом АС. Описана картина энтезита, уделено внимание системным внесуставным проявлениям ВЗК, в ряде случаев ассоциированным с суставным синдромом (узловатая эритема и увеит). Охарактеризованы рентгенологические изменения периферических суставов и позвоночника при различных вариантах поражения опорно-двигательного аппарата у больных с ВЗК. Приведены данные литературы, касающиеся лечения суставного синдрома у больных ЯК и БК. Отмечена необходимость дифференцированного подхода к лечению периферического артрита и поражения аксиального скелета, оценена роль нестероидных противовоспалительных препаратов, сульфасалазина, генно-инженерных биологических препаратов в лечении суставного синдрома при ВЗК. Указано, что пациентов с ВЗК, имеющих ревматологические проявления, должны наблюдать совместно гастроэнтеролог и ревматолог.

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