RESUMEN
Disease onset and type A behavioral pattern (TABP) are important characteristics of the clinical manifestations of chronic diseases. The aim of this work is to study the prevalence and role of TABP in patients with rheumatoid arthritis (RA) with the onset of the disease at different periods of ontogenesis. 82 patients were examined, which were divided into groups depending on the age of RA onset. The first group included patients with RA onset at reproductive age (from 18 to 44 years). The second group included patients with the onset of RA in the middle age (from 45 to 59 years). The third group consisted of patients with the onset of RA in old age (from 60 to 74 years). The fourth group consisted of patients with the onset of RA in old age (75 years and older). Diagnosis of TABP was carried out using a special questionnaire. The group with a debut in the reproductive period had the largest number of patients with RA of the 1st and 2nd line of relationship, as well as the highest incidence of TABP, which was associated with a greater expression of such personal qualities as ambition and hostility. This group had the highest number of ankylosis, as well as the highest frequency of systemic lesions. The second group demonstrated classic rheumatoid patterns. The third group with debut in old age had the most favorable clinical picture, incl. the lowest immunological activity in terms of the Ñirculating immune complexes (CICs) level, associated with the lowest severity of articular syndrome, with the lowest number of erosions and the frequency of systemic manifestations. The fourth group with a debut in old age demonstrated the highest inflammatory activity and specific immunological activity in terms of rheumatoid factor and CICs levels, as well as the highest clinical severity of the articular syndrome. Thus, the ontogenetic debut of RA determines its clinical and laboratory features and is associated with the presence and characteristics of TABP.
Asunto(s)
Artritis Reumatoide , Anciano , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/epidemiología , Humanos , Factor ReumatoideRESUMEN
Ontogenetic debut of diseases can determine clinico-pathogenetic differences in disease variants. The aim of the study was to determine the clinical and laboratory features of the variants of rheumatoid arthritis (RA) associated with autoimmune thyroiditis (AIT) in patients with various ontogenetic debut of the disease. A total of 53 patients with a combination of RA and AIT (mean age 63,92±1,6 years, 92% of patients - women, duration of rheumatoid arthritis - 10,0±1,11 years, disease activity on the DAS28 scale - 5,67±0,14 points). Patients with the debut of joint syndrome in the reproductive period had the highest antibody titer to the cyclic citrullinated peptide (ACCP) and close correlation between the titer of rheumatoid factor (RF) and tobacco smoking experience. Patients with debut joint syndrome in the menopausal period were characterized by geroprotective status, having the largest number of centenarians in the family and a significant negative correlation between the titre of ACCP and this significative, and also the greatest vulnerability to the action of other trigger factors of arthritis, which was confirmed by a close correlation of specific rheumatoid immunological parameters with smoking experience and the presence of an infectious disease in the period preceding the articulate debut of the RA, and also least rate of glomerular filtration. Patients with the debut of the joint syndrome in the early involutionary period were characterized by the presence of a gerontological immunological phenotype, which was manifested by the highest level of RF in the serum, as well as by the faster course of the disease from the joint debut to the unfolded clinical picture. CONCLUSIONS: The ontogenetic analysis of the features of RA associated with AIT showed the presence of ontogenetic clinico-pathogenetic forms of the disease, which may further have implications for clinical practice.