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