Цель исследования -изучение влияния диагноза анкилозирующего спондилита (АС) на планирование пациентками беременности, их отношения к применению лекарственных средств (ЛС) при подготовке и во время гестации, а также оценка компетентности врачей в вопросах беременности при АС. Пациенты и методы. Представлены данные трех исследований, основанных на анкетировании пациенток с АС и ревматологов. Результаты и обсуждение. Анкетирование выявило уменьшение числа беременностей на одну женщину после дебюта АС. Узнав о диагнозе АС, 70% пациенток сообщили о пересмотре планов на материнство, при этом большинство женщин (80%) ответили, что решатся на беременность, однако постоянно будут испытывать дискомфорт и чувство страха за свое здоровье и здоровье будущего ребенка. Не были настроены на беременность в связи с развитием у них АС 13,9% респонденток независимо от отсутствия или наличия детей, рожденных в здоровый период жизни. Только 50% пациенток обсуждали вопросы планирования беременности с ревматологом, при этом треть из них не получили необходимой информации. Лишь четверть больных допускали продолжение терапии АС при подготовке к зачатию и во время гестации. В целом российские ревматологи имеют достаточный объем знаний об исходах беременности при АС, в частности о факторах, влияющих на ее благоприятный исход, основах диспансерного наблюдения за беременными. В то же время 18% ревматологов ожидают усиления активности АС при гестации, более 2/3 считают наличие сакроилиита показанием к оперативным родам, а 30% готовы отменить лекарственные средства (ЛС), разрешенные к применению до беременности. Выводы. Дефицит информации, касающейся планирования и течения беременности при АС, риска обострения заболевания и безопасности терапии при гестации, отмечается как у больных АС, так и у ревматологов. Необходимо проведение образовательных мероприятий для врачей и специализированных школ для пациенток детородного возраста и членов их семей, посвященных проблеме беременности при АС.
Functional outcomes and synovial fluid (SF) cytokine concentrations in response to platelet-rich plasma (PRP) or stromal vascular fraction (SVF) post-treatments following open wedge high tibial osteotomy (HTO) in 20 patients with knee osteoarthritis (OA) were examined. Six weeks after surgery, the knees of 10 patients were injected with autologous PRP (PRP subgroup), while another 10 patients were injected with autologous SVF (SVF subgroup) and monitored for 1.5 years. Pain assessment (VAS score) and functional activity (KOOS, KSS, Outerbridge, and Koshino scores) were applied. PRP subgroup performed better compared with the SVF subgroup according to KOOS, KSS, and VAS scores, while the SVF subgroup demonstrated better results according to Outerbridge and Koshino testing and produced more pronounced cartilage regeneration in the medial condyle and slowed down cartilage destruction in its lateral counterpart. SF was collected before and one week after PRP or SVF injections and tested for concentrations of 41 cytokines (Multiplex Assay). In the PRP subgroup, a significant decrease in IL-6 and CXCL10 synovial concentrations was accompanied by an increase in IL-15, sCD40L, and PDGF-AB/BB amounts. The SVF subgroup demonstrated a significant decrease in synovial TNFα, FLT-3L, MIP-1β, RANTES, and VEGF concentrations while SF concentrations of MCP-1 and FGF2 increased. Both post-treatments have a potential for increased tissue regeneration, presumably due to the downregulation of inflammation and augmentation of synovial growth factor concentrations.
BackgroundThe latest data show that axial psoriatic arthritis (PsA) is less symptomatic, as compared with ankylosing spondylitis, and is associated with distinct radiographic features (1).ObjectivesTo analyze clinical characteristics of PsA patients (pts) with axial involvement, using data from a real-life outpatient cohort.Methods50 pts (M/F–30 /20) with PsA according to CASPAR criteria were included. All pts had either a present or past history of back pain, which rheumatologist suspected to be axial involvement. Pts’ age 42.0 [34.0; 54.0], disease duration 3.5 [0.3; 32.5] years. Pts underwent standard clinical examination of PsA activity: Ме BASDAI was 6.2 [3.8; 8.0], ASDAS-СRP 3.5 [2.5; 4.8], DAPSA 38,1 [20,2; 52,2], CRP 12.4 [0.3; 94.6] mg/L. All pts were evaluated for presence of inflammatory back pain (IBP) by ASAS criteria. HLA B27 antigen status was observed. Physical examination included Bath Ankylosing Spondylitis Metrology Index (BASMI). Pts underwent X-ray of sacroiliac joints (pelvic radiographs), cervical and lumbar spine, and hands and feet. Radiographic sacroiliitis (rSI) was defined as bilateral grade ≥ 2 or unilateral grade ≥ 3. All radiographs were interpreted by two experienced musculoskeletal radiologists. Me [Q25; Q75], Pierson-χ2 tests were performed. All p<0.05 were considered to indicate statistical significance.ResultsIBP was detected in 31 (62.0%) pts, while 19 (38.0%) pts didn’t meet IBP criteria – they had chronic back pain (CBP); 12 (24.0%) of all pts had episodic mild back pain. In 15 (30.0%) pts back pain started at age of above 40. RSI was found in 29 (58.0%) pts, while mostly symmetrical in 23/29 (79.3%) cases. Unilateral grade 2 sacroiliitis was found in 4 (8.0%) pts. 13/29 (44.8%) pts developed rSI without IBP. 38 (76%) pts had erosive arthritis, 18 (36%) pts had numerous erosions. HLA-В27 antigen was positive in 16 (32.0%) of pts. A correlation was revealed between the presence of rSI and limited spine mobility by BASMI (r=0.347). Association was found between rSI and numerous erosions (p=0.003), as well as between rSI and juxtaarticular new bone formation on hands and feet X-rays (р = 0.02). Syndesmophytes were found in 28 (56%) cases. 11 (22%) pts developed syndesmophytes without rSI. Asymmetrical syndesmophytes in the lumbar spine were found in 7/13 (53.8%) pts, vertebral non-bridging syndesmophytes in the lumbar and/or cervical spine in 16 (57.1%) pts. Restricted neck rotation was found in 85% of cases. Syndesmophytes in the cervical spine were found twice as often (26 pts) as in the lumbar spine (13 pts); 14 (28%) pts had isolated involvement of the cervical spine. An association was detected between asymmetrical syndesmophytes and radiographic changes on hands and feet X-rays such as osteolysis (р = 0.005) and juxtaarticular new bone formation (р = 0.05).ConclusionAxial PsA is often asymptomatic, one third of pts develop back pain at age above 40. HLA-B27 positivity was found in only 32% of pts. Pts with rSI are more likely to have severe peripheral arthritis with multiple joint erosions. Radiographic SI is associated with juxtaarticular new bone formation, which may indicate common mechanisms of bone formation in axial and peripheral skeleton. Syndesmophytes may occur in absence of sacroiliitis. Cervical spine involvement is more frequent in axial PsA pts. Asymmetrical syndesmophytes characteristic of PsA, are associated with typical, for PsA, radiographic changes on hands and feet X-rays, such as osteolysis and juxtaarticular new bone formation.References[1]J. Feld et al. Nat Rev Rheumatol. 2018;14(6):363-371.Disclosure of InterestsELENA GUBAR: None declared, Tatiana Korotaeva Speakers bureau: Pfizer, MSD, Novartis, AbbVie, Janssen, Lilly, Celgene, JSC BIOCAD and Novartis-Sandoz, Yulia Korsakova Speakers bureau: Novartis, Elena Loginova Speakers bureau: Janssen, Svetlana Glukhova: None declared
Our results suggest that the expressions of MMP-9 and ULK1 might be associated with disease activity. Increased baseline gene expressions of RUNX2, p21 and caspase 3 in the peripheral blood might predict better responses to MTX therapy.
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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