This dissertation is devoted to the diagnosis and treatment of spondyloarthritis (SpA). The average time from the onset of the first symptoms to the diagnosis of SpA is 6.5 years for men and 8.8 years for women [1]. The reasons for this delay are complex. Despite the typical clinical signs of SpA, sometimes the diagnosis at an early stage of the disease remains quite difficult even for a qualified rheumatologist because less than half of patients with SpA have changes in traditional laboratory markers of systemic inflammation (C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)). Also CRP and ESR do not always correlate with activity and prognosis. Diagnostically significant radiological changes in the spine and sacroiliac joints (SIJ) are revealed late - only a few years after the onset of the disease, and magnetic resonance imaging (MRI) may not be used in all patients as it often visualizes insufficiently specific changes. In this regard, it is promising and relevant to identify markers of inflammation of bone tissue and ossification, which could help in diagnosing of SpA at the beginning of the disease and would have an advantage over standard laboratory markers of inflammation (CRP and ESR) and instrumental methods in reflecting of inflammation in bone and joints of the spine.
Difficulties in the early diagnosing of SpA, a wide range of clinical manifestations, insufficient effectiveness in assessing of disease activity, low informativeness of traditional laboratory parameters, lack of specific laboratory changes and methods for predicting response to treatment prompted this study.
The aim of this study is to improve the diagnosis and predict the response to treatment in patients with SpA, based on a comprehensive study of clinical indicators, integrated indices, inflammatory and chronic changes in SIJ according to MRI, traditional and immunobiochemical laboratory markers of inflammation and ossification (TGF-β1, sclerostin, Dkk-1 and WNT3).
Objectives of the study:
1. To review the features of clinical manifestations, the results of laboratory and instrumental examinations depend on sex and age in patients with axial and peripheral forms of SpA.
2. To analyze the relationship between traditional laboratory markers of inflammation, indices of disease activity and functional status, active and chronic changes in the SIJ according to MRI in patients with SpA.
3. To measure the serum levels of immunobiochemical markers of inflammation and ossification (TGF-β1, sclerostin, Dkk-1 and WNT3), to determine their relationship with clinical, laboratory and MRI signs of active and chronic changes in the SIJ in patients with SpA.
4. To determine the diagnostic value of immunobiochemical markers of inflammation and ossification in SpA patients.
5. To evaluate the dependence of the effectiveness of drug treatment of SpA on the clinical, laboratory, instrumental indicators and on the level of immunobiochemical markers of inflammation.
