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The paper gives the recommendations for the assessment of disease activity and functional status in patients with ankylosing spondylitis in clinical practice, which have been developed by experts, by taking into account international and Russian experience in managing these patients.

В статье представлены рекомендации по лекарственной терапии аксиальных спондилоартритов, разработан-ные Экспертной группой по изучению спондилоартритов (ЭкСпА). Рекомендации описывают тактику веде-ния пациентов в наиболее частых клинических ситуациях, направленную на обеспечение максимальной эф-фективности и безопасности лечения. Ключевые слова: спондилоартриты; аксиальные спондилоартриты; анкилозирующий спондилит; болезнь Бехтерева; нестероидные противовоспалительные препараты; ингибиторы фактора некроза опухоли α; ин-гибиторы интерлейкина 17; безопасность терапии. Для ссылки: Гайдукова ИЗ, Ребров АП, Лапшина СА и др. Применение нестероидных противовоспали-тельных препаратов и генно-инженерных биологических препаратов для лечения аксиальных спондилоар-тритов. Рекомендации Экспертной группы по изучению спондилоартритов при Общероссийской общест-венной организации «Ассоциация ревматологов России». Научно-практическая ревматология. 2017;55(5):474-484. The paper gives recommendations for the drug therapy of axial spondyloarthritides, which have been developed by the Spondyloarthritis Study Group of Experts. The recommendations describe the patient management tactic in the most common clinical situations, which is aimed at maximizing the efficacy and safety of treatment. Key words: spondyloarthritides; axial spondyloarthritides; ankylosing spondylitis; Bechterew's disease; nonsteroidal anti-inflammatory drugs; tumor necrosis factor-α inhibitors; interleukin-17 inhibitors; safety of therapy. For reference: Gaidukova IZ, Rebrov AP, Lapshina SA, et al. Use of nonsteroidal anti-inflammatory drugs and biological agents for the treatment of axial spondyloarthritides. USE OF NONSTEROIDAL ANTI-INFLAMMATORY DRUGS AND BIOLOGICAL AGENTS FOR THE TREATMENT OF AXIAL SPONDYLOARTHRITIDES. RECOMMENDATIONS OF THE SPONDYLOARTHRITIS STUDY GROUP OF EXPERTS, ALL-RUSSIAN PUBLIC ORGANIZATION «THE ASSOCIATION OF RHEUMATOLOGY

BackgroundDepression is one of the precursors of psoriasis and psoriatic arthritis (PsA) development. It was found that depression and anxiety negatively affect the achievement of remission in PsA. B. Michelsen 2017] Interrelation of anxiety, depression and fatigue (according to patient-reported outcomes) with disease activity, erosive arthritis and skin lesion severity in early PsA hadn’t been sufficiently studied.ObjectivesTo study anxiety, depression and fatigue disorders (according to patient-reported outcomes) and their correlation with disease activity, erosive arthritis and severity of psoriasis in early PsA patients (pts).Methods78 pts (M/F–39/39) with early PsA according to CASPAR criteria were included; all pts had peripheral arthritis for ≤2 years; mean age 36.5±10.7 years, disease duration 12.2±10.3 mo. It was a treatment naïve cohort. All pts underwent standard clinical examination of PsA activity. Mean disease activity indexes (DAS)=4. 0±1.4, DAS28=4.2±1.1. 78 patients were studied for fatigue (according to FACIT), patient global disease activity (PGA), patients pain measured by VAS, and Health Assessment Questionnaire (HAQ); 66 patients (M/F–33/33) were studied for anxiety and depression (according to HADS). At HADS score ≥8 patients had anxiety and depression disorders. Higher scores for FACIT scales indicate better quality of life (less fatigue). Skin lesion severity was evaluated in terms of body surface area (BSA) affected and Psoriasis Area Severity Index (PASI). When BSA was ≥3%, PASI was calculated. PASI≥11 indicates moderate and severe psoriasis. Descriptive statistics was used, M±SD, Me [Q25;Q75], U-test were performed; p<0.05 was considered to indicate statistical significance.ResultsMean FACIT score was low amounting to 35.3±9.6, testifying increased fatigue; mean anxiety index was 5.7±3.1, depression index was 3.8±3.0. Anxiety disorders were detected in 16 out of 66 (24.2%) pts, depression disorders in 9 out of 66 (13.0%) pts. Negative correlation was found between FACIT score and DAS (r=-0.26), DAS28 (r=-0.26), CRP (r=-0.27), PGA (r=-0.35); and pain VAS (r=-0.25). Depression was more pronounced in pts with erosive arthritis in hands and/or feet (r=0.31). Negative correlation of FACIT score (r=-0.54), correlation of anxiety (r=0.26) and depression (r=0.33) indexes was found with health-related functional indexes according to HAQ. HADS indexes (anxiety and depression) are cross-correlating (r=0.51) and are negatively correlating with FACIT scores (r=-0.49 and r=-0.48, accordingly). An association was found of anxiety and depression indexes with the severity of psoriasis PASI index (r=0.38 and r=0.31, accordingly).ConclusionsIn early treatment-naïve PsA patients, increased fatigue and in a quarter of cases anxiety disorders, in 13% of patients depression disorders had been found. Psychological disorders are associated with PsA activity, the severity of psoriasis and joints erosion. Fatigue, anxiety and depression in early PsA patients result in the reduction of their functional capacity.Di...

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