Abstract
Objective: to reveal the characteristic symptoms and syndromes of early-stage psoriatic arthritis (ePsA), which are pivotal to its early diagnosis. Patients and methods. Fifty-one patients with a PsA duration of less than 2 years (mean 12 months) were examined. The diagnosis of PsA was established on the basis of the conventional CASPAR criteria and the Russian criteria developed by the expert method. The conventional current criteria, including the number of tender and swollen joints, DAS28, values of acute-phase indicators, were used to detect inflammatory activity. Skin syndrome was evaluated using the Psoriasis Area and Severity Index (PASI). X-ray study of the hands, distal and proximal feet, pelvis, and other involved joints and MRI of the distal hands/feet were performed. The Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and reduced GUESS were used to assess enthesopathy. Results. The types of articular syndrome in ePsA were identified in accordance of the duration of the disease. The authors determined the characteristic features of arthritis, spondylitis, enthesitis, and dactylitis, their diagnostic value and associations with other manifestations in the first 2 years of PsA. There was a relationship of dermatitis and psoriatic onychopathy to the clinical picture of articular syndrome. Conclusion. ePsA is characterized by marked heterogeneity of articular syndrome with predominantly mono/oligoarthritic and polyarthritic articular syndrome. The significant signs are enthesitis and dactylitis, which serve as risk factors for the unfavorable course of the disease.
Highlights
Objective: to reveal the characteristic symptoms and syndromes of early-stage psoriatic arthritis, which are pivotal to its early diagnosis
The diagnosis of PsA was established on the basis of the conventional CASPAR criteria and the Russian criteria developed by the expert method
The types of articular syndrome in early-stage psoriatic arthritis (ePsA) were identified in accordance of the duration of the disease
Summary
Бадокин В.В.1, Трошкина И.А.2 1ФГБОУ ДПО «Российская медицинская академия последипломного образования» Минздрава России, Москва, Россия; 2ФГБНУ «Научно-исследовательский институт ревматологии им. [8] наблюдали у больных ранним ПсА (рПсА) в течение первого года болезни олигоартритический вариант суставного синдрома в 42% случаев, полиартритический – в 28%, спондилоартритический – в 23%. Полиартритический вариант суставного синдрома при ПсА, напротив, чаще встречается на более поздних стадиях заболевания – в 40–68% случаев [8, 10]. [11], изучая больных ПсА и ревматоидным артритом (РА), установили, что полиартритический (ревматоидоподобный) вариант суставного синдрома имеет больше общих черт с другими СпА, чем с РА. Это относится к наличию характерных для ПсА экстраартикулярых проявлений (в частности, часто встречающейся энтезопатии), дактилита, артрита ДМФС, спондилита, типичных рентгенологических признаков поражения суставов и позвоночника (различные виды костной резорбции, сакроилиит, паравертебральные оссификаты). Распространенность такого варианта суставного синдрома при рПсА со средней длительностью заболевания 12 мес составила 4–23%. Возраст больных рПсА варьировал от 19 до 72 лет; соотношение муж-
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