Donetsk National Medical University, Lyman, Ukraine
Background. Lesion of the joints and periarticular tissues is one of the main features of all systemic vasculitis. Changes in the musculoskeletal system in small vessel vasculitis associated with antineutrophil cytoplasmic antibodies (microscopic polyangiitis, Wegener’s granulоmatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)) are now widely discussed. There are no such studies for medium-sized-vessel polyarteritis nodosa. The purpose and tasks of the study were to assess the nature of the course and risk factors for the pathology of the joints and periarticular tissues in polyarteritis nodosa, to identify prognostic criteria. Material and methods. There were 39 patients with polyarteritis nodosa under supervision: 62 % of men and 38 % of women aged 17–75 years (average of 44 years). The duration of the disease was on average 9 years, the ratio of acute and chronic course of the pathological process was 1 : 7, minimal, moderate and high degree of acti-vity of the disease — 1 : 2 : 2. Results. Changes in the locomotor system were detected in 97 % of cases of polyarteritis nodosa. Peripheral neuropathy was diagnosed in 82 % of patients, peripheral arthritis — in 63 %, limb myositis — in 56 %, tendovaginitis — in 28 %, enthesopathy — in 23 %, sacroiliitis and spondylopathy — in 21 %, respectively, algodystrophy — in 8 % that was associated with systemic manifestations of the disease (primarily, with da-mage to the skin and heart), kidney function (with arthritis of the ankle joints and the formation of ligamentosis), the degree of activity of the pathological process (with parameters of activity and severity of the articular syndrome). The severity of arthropathy is directly correlated with the level of mean blood pressure, the presence of left ventricular diastolic dysfunction, tendovaginitis and enthesopathy, while the level of peripheral vascular resistance has prognostic significance in relation to limb myositis. Conclusions. Lesion of the musculoskeletal system is observed in almost all cases of polyarteritis nodosa, which requires further study of the pathogenesis of this pathology and the development of an individualized drug treatment technology for such patients.
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