THE LESION OF THE MUSCULOSKELETAL SYSTEM IN ANCA-ASSOCIATED SYSTEMIC VASCULITIS

Iermolaieva M.V., Pomazan D.V., Syniachenko O.V., Suiarko V.I., Verzilov S.M.

• Донецкий национальный медицинский университет, Лиман

Summary. Relevance. Lesion of the joints and paraarticular tissue refers to the most common signs of systemic vasculitis (SV) associated with antineutrophil cytoplasmic antibodies (ANCA) — with microscopic polyangiitis (MPA), granulomatosis with Wegener polyangiitis (GPA), eosinophi­lic granulomatosis with polyangiitis Churg — Strauss (EGP), but the course and pathogenesis of the pathology of the musculoskeletal system in such patients requires further study. The purpose and objectives. To conduct a comparative assessment of the clinical and X-ray sonographic signs of joints and paraarticular tissue pathology in individual forms of ANCA-SV, to establish the features of pathogenetic constructions, to identify risk factors. Material and methods. Under control there were 147 patients with ANCA-SV (89 with MPA, 28 with GPA, 30 with EGP), respectively, with an average age of 45, 46 and 42 years, and a disease duration of 7, 4 and 11 years. The ratio of the minimum, moderate and high degrees of disease activity in these groups, respectively, was 1:3:6, 1:7:6 and 1:3:4. Results. The lesion of the musculoskeletal system was found in 79% of the number of patients with MPA, 61% of GPA and 77% of EGP, while MPA was more characteristic of myositis of the extremities (39%), for GPA — peripheral neuropathy (71%) and algal dystrophy (18%), for EGP, sacroiliitis (17%), spondylopathy (26%), tendovaginitis (30%) and enthesopathy (26%). In case of MPA, frequent involvement of the knee, ankle and wrist joints, with EGP — maxillary, while with GPA there were no cases of arthritis of the sternoclavicular, metatarsophalangeal and hip joints. Integral severity of viscerites in patients with MPA had simu­ltaneous dispersion and direct correlations with the development of osteouzurs, with GPA — with the presence of intra-articular Hoff bodies, with EPA — ligamentisis. With parameters in the blood ANCA (antibodies to myeloperoxidase and proteinase-3) in patients with MPA was the formation of peri­pheral arthritis is closely related, and with EGP — tendovaginitis, in cases of MPA in the development of changes in the musculoskeletal system, antibodies to cardiolipin are important, GPA — vascular endothelial dysfunction, and EGP — antibodies to deoxyribonucleic acid. The pathogenesis of ANCA-SV requires the creation of an individualized medical treatment technology for lesions of the musculoskeletal system.