Трудности подбора генно-инженерной терапии у пациента с поражением сердечно-сосудистой системы при анкилозирующем спондилите (болезни Бехтерева)

Abstract

Spondylarthritis (SpA) is a group of chronic inflammatory diseases affecting the spine, joints, and entheses. It is characterized by common clinical, radiological, and genetic traits. Cardiovascular disorder (CVD) is an important factor in determining the prognosis and treatment options for SpA. Ankylosing spondylitis (AS) is the reference axial SpA, where CVD is a manifestation of both systemic inflammation and rapid atherosclerotic lesion secondary to the disease. Treating AS associated with CVD is challenging because nonsteroidal anti-inflammatory drugs and physical activity exacerbate cardiovascular disease, while experience with gene therapy and targeted therapy is limited. Therefore, it is important to accumulate real-world clinical data on treating patients with AS and CVD. This article discusses the case of a patient with AS and CVD who developed secondary resistance to tumor necrosis factor α inhibitor. The patient required complex cardiotropic therapy, including implantable cardioverter defibrillator insertion and replacement of genetically engineered drug with interleukin 17A inhibitor. The article also discusses the rationale for the chosen management strategy from a CVD perspective. KEYWORDS: ankylosing spondylitis, Bechterew's disease, axial spondylarthritis, atrioventricular block, cardiovascular comorbidity, biological therapy, interleukin 17A. FOR CITATION: Gaydukova I.Z., Sidorchuk I.V., Chudinov A.L., Inamova O.V. Difficulties in selecting genetically engineered therapy in a patient with cardiovascular disorder in ankylosing spondylitis (Bechterew's disease). Russian Medical Inquiry. 2024;8(2):89–93 (in Russ.). DOI: 10.32364/2587-6821-2024-8-2-6.