nogrЭкспериментальная и клиническая гастроэнтерологияExperimental and Clinical Gastroenterology1682-8658«Global Media Technologies»10.31146/1682-8658-ecg-199-3-115-124nogr-1946Research ArticleОБЗОРREVIEWИммуновоспалительная коморбидность: клинические и патогенетические аспекты сочетания воспалительных заболеваний кишечника и спондилоартритовImmuno-mediated comorbidity: clinical and pathogenetic aspects of the infl ammatory bowel diseases and spondyloarthritis associationhttps://orcid.org/0000-0002-7588-8089БабаеваА. Р.BabaevaA. R.

Бабаева Аида Руфатовна - доктор медицинских наук, профессор, заведующий кафедрой факультетской терапии.

400131, Волгоград, Павших Борцов пл., 1

Aida R. Babaeva - MD, PhD, DSc, Head of the Department of Faculty Therapy; Scopus Author ID: 7005848648, Researcher ID: B-2656–2017.

1, Pavshikh Bortsov sq., Volgograd, 400131

arbabaeva@list.ruhttps://orcid.org/0000-0003-0485-6802ОсадчукМ. А.OsadchukM. A.

Осадчук Михаил Алексеевич - доктор медицинских наук, профессор, заведующий кафедрой поликлинической терапии ИКМ им. Н.В. Склифосовского.

119991, Москва, Трубецкая ул., 8/2

Mikhail A. Osadchuk - MD, PhD, DSc, Head of the Departmen t of Outpatient Therapy; Scopus Author ID: 6701741609, Researcher ID: В-9896–2018.

8/2, Trubetskaya str., Moscow, 119991

https://orcid.org/0000-0003-3131-5737СолоденковаК. С.SolodenkovaK. S.

Солоденкова Карина Сергеевна - кандидат медицинских наук, доцент кафедры поликлинической терапии ИКМ им. Н.В. Склифосовского.

119991, Москва, Трубецкая ул., 8/2

Karina S. Solodenkova - MD, Associate Professor of the Department of Outpatient Therapy; Scopus Author ID: 35338131300, Researcher ID: ABA-6147-2020.

8/2, Trubetskaya str., Moscow, 119991

https://orcid.org/0000-0002-1762-6056КалининаЕ. В.KalininaE. V.

Калинина Елена Валерьевна - кандидат медицинских наук, доцент кафедры факультетской терапии.

400131, Волгоград, Павших Борцов пл., 1

Elena V. Kalinina - MD, Associate Professor of the Department of Faculty Therapy.

1, Pavshikh Bortsov sq., Volgograd, 400131

https://orcid.org/0000-0002-6150-2093ВидикерР. В.VidikerR. V.

Видикер Раиса Викторовна - кандидат медицинских наук, доцент кафедры факультетской терапии.

400131, Волгоград, Павших Борцов пл., 1

Raisa V. Vidiker - MD, Associate Professor of the Department of Faculty Therapy; Scopus Author ID: 5720–3727.

1, Pavshikh Bortsov sq., Volgograd, 400131

ФГБОУ ВО Волгоградский государственный медицинский университет Минздрава РоссииРоссияVolgograd State Medical UniversityRussian FederationФГАОУ ВО Первый МГМУ имени И.М. Сеченова Минздрава России (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian Federation20220410202203115124Copyright © Бабаева А.Р., Осадчук М.А., Солоденкова К.С., Калинина Е.В., Видикер Р.В., 20222022Бабаева А.Р., Осадчук М.А., Солоденкова К.С., Калинина Е.В., Видикер Р.В.Babaeva A.R., Osadchuk M.A., Solodenkova K.S., Kalinina E.V., Vidiker R.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nogr.org/jour/article/view/1946

Проблема коморбидности приобретает все большее значение в современной медицине и здравоохранении. К числу коморбидной взаимоотягощающей патологии можно отнести сочетание воспалительных заболеваний кишечника (ВЗК) и спондилоартритов (СпА), генез которых тесно связан с иммунным воспалением. В реальной клинической практике нередко имеет место поздняя диагностика указанных коморбидных процессов, что отражается на качестве и эффективности лечения и ухудшает исходы заболеваний. С целью привлечения внимания специалистов разного профиля к иммуновоспалительной коморбидности в статье представлены актуальные данные об ассоциации между ВЗК и СпА с анализом частоты поражения суставов и позвоночника при язвенном колите (ЯК) и болезни Крона (БК), а также частоты выявления поражений кишечника при различных фенотипах Сп А. Показано, что суставные поражения при ВЗК и кишечные при СпА, как правило, возникают при тяжелых и среднетяжелых формах указанных заболеваний, протекающих с высокой либо умеренной активностью. HLA B27 генотип более характерен для лиц с манифестным СпА, в т. ч. развившемся на фоне ВЗК. Сочетание ВЗК и СпА обусловлено сходными нарушениями иммунорегуляции, функционального состояния клеток нативного и адаптивного иммунитета, дисбалансом цитокинов. Эти механизмы стали основанием для применения биологической и таргетной терапии при ВЗК и СпА, а также при их сочетании. Показано, что примерно у половины резистентных к стандартным препаратам пациентов может быть достигнута клиническая ремиссия на биологической терапии. Таким образом, для объективизации тяжести иммуновоспалительного процесса и улучшения исходов целесообразно своевременно диагностировать наиболее вероятную коморбидную патологию и учитывать этот фактор для оптимизации лечения.

Background

Background. The problem of comorbidity is becoming increasingly important in modern medicine and healthcare. A combination of infl ammatory bowel diseases (IBD) and spondyloarthritis (SpA), the genesis of which is closely related to immune infl ammation, can be attributed to the number of comorbid mutually aggravating pathology. In real clinical practice, there is often a late diagnosis of these comorbid processes, which aff ects the quality and eff ectiveness of treatment and worsens the outcomes of diseases.

Aim

Aim. In order to attract the attention of specialists of various profi les to immuno-i nfl ammatory comorbidity, the article presents current data on the association between IBD and SpA with an analysis of the frequency of joint and spine lesions in ulcerative colitis (UC) and Crohn’s disease (CD), as well as the frequency of detection of intestinal lesions in various SpA phenotypes.

Basic provisions

Basic provisions. It has been shown that joint lesions in IBD and intestinal lesions in SpA, as a rule, occur in severe and moderate forms of these diseases, occurring with high or moderate activity. The HLA B27 genotype is more typical for individuals with manifest SpA, including developed against the background of IBD. The combination of IBD and SpA is caused by similar disorders of immunoregulation, the functional state of cells of native and adaptive immunity, and an imbalance of cytokines. These mechanisms have become the basis for the use of biological and targeted therapy in IBD and SpA, as well as in their combination. It has been shown that approximately half of patients resistant to standard drugs can achieve clinical remission on biological therapy.

Conclusions

Conclusions. Thus, in order to objectify the severity of the immuno- infl ammatory process and improve outcomes, it is advisable to diagnose the most likely comorbid pathology in a timely manner and take this factor into account to optimize treatment.

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The authors declare that there are no conflicts of interest present.