medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2025-9-47-52medalphabet-4387Research ArticleСтатьиКлинический случай желудочно-кишечного кровотечения у пациентки с системной склеродермиейA clinical case of gastrointestinal bleeding in a patient with systemic sclerosishttps://orcid.org/0000-0002-5031-6930ТихомироваН. Ю.TikhomirovaN. Yu.

Тихомирова Надежда Юрьевна - к.м.н., доцент, доцент кафедры факультетской терапии ФГБОУ ВО «КубГМУ» Минздрава России; врач-ревматолог ревматологического центра поликлиники СКАЛ ГБУЗ «ККБ № 2».

Краснодар

Nadezhda Yu. Tikhomirova - PhD Med, Associate Professor, Associate Professor at Dept of Faculty Therapy, Kuban State Medical University; rheumatologist at h Rheumatology Center of the SKAL Polyclinic, Regional clinical Hospital No. 2.

Krasnodar

tihomirovum@rambler.ruhttps://orcid.org/0000-0002-5275-3261ЕлисееваЛ. Н.EliseevaL. N.

Елисеева Людмила Николаевна - д.м.н., профессор, зав. кафедрой факультетской терапии.

Краснодар

Lyudmila N. Eliseeva - DM Sci (habil.), professor, head of Dept of Faculty Therapy.

Krasnodar

https://orcid.org/0009-0006-8869-2217БелозероваН. П.BelozerovaN. P.

Белозёрова Наталья Павловна - к.м.н., ассистент кафедры факультетской терапии ФГБОУ ВО «КубГМУ» Минздрава России; зав. ревматологическим центром поликлиники СКАЛ ГБУЗ «ККБ № 2».

Краснодар

Natalia P. Belozerova - PhD Med, assistant professor of Faculty Therapy, Kuban State Medical University; head of Rheumatology Center of the SKAL Polyclinic, Regional clinical Hospital No. 2.

Krasnodar

https://orcid.org/0000-0002-3720-1346КаменеваЕ. С.KamenevaE. S.

Каменева Елена Сергеевна - к.м.н., ассистент кафедры поликлинической терапии с курсом общей врачебной практики (семейной медицины) ФПК и ППС ФГБОУ ВО «КубГМУ» Минздрава России; зав. поликлиникой СКАЛ ГБУЗ «ККБ № 2».

Краснодар

Elena S. Kameneva - PhD Med, assistant at Dept of Polyclinic Therapy with a Course of General Medical Practice (Family Medicine) Faculty of Advanced Training and Professional Retraining of Specialists, Kuban State Medical University; Head of the SKAL Polyclinic, Regional clinical Hospital No. 2.

Krasnodar

https://orcid.org/0000-0001-8999-6331БочарниковаМ. И.BocharnikovaM. I.

Бочарникова Марина Ивановна - к.м.н., доцент кафедры пропедевтики внутренних болезней.

Краснодар

Marina I. Bocharnikova - PhD Med, associate professor at Dept of Propaedeutics of Internal Diseases.

Krasnodar

ФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава России; ГБУЗ «Краевая клиническая больница № 2»РоссияKuban State Medical University; Regional clinical Hospital No. 2Russian FederationФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава РоссииРоссияKuban State Medical UniversityRussian Federation20250606202509Ревматология в общей врачебной практике (1)4752Copyright © Тихомирова Н.Ю., Елисеева Л.Н., Белозерова Н.П., Каменева Е.С., Бочарникова М.И., 20252025Тихомирова Н.Ю., Елисеева Л.Н., Белозерова Н.П., Каменева Е.С., Бочарникова М.И.Tikhomirova N.Y., Eliseeva L.N., Belozerova N.P., Kameneva E.S., Bocharnikova M.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/4387

В статье приведено клиническое наблюдение, демонстрирующее, что системная склеродермия – это заболевание, имеющее многообразные клинические проявления, среди которых часто встречается поражение желудочно-кишечного тракта (ЖКТ). Традиционное описание этих нарушений включает развитие стриктур нижней трети пищевода вследствие ее рубцовых изменений при рецидивирующем язвенном поражении, желудочные кровотечения из телеангиэктазий слизистой оболочки желудка или язвенных дефектов на фоне ишемических изменений и вследствие лекарственной терапии. Развитие кровотечения из ЖКТ является жизнеугрожающим осложнением ССД. Причинами развития желудочно-кишечного кровотечения у данной категории пациентов могут быть как аномалии слизистой оболочки ЖКТ, ассоциированные с проявлениями заболевания, так и влияние базисной медикаментозной терапии, а также наличие и терапия сопутствующих заболеваний. В рассматриваемом аспекте ранняя диагностика изменений слизистой оболочки пищеварительного тракта является ключевым моментом в выборе методов динамического контроля за течением болезни и в определении тактики медикаментозной терапии пациентов с учетом соотношения «польза/риск» при достижении контроля симптомов с улучшением прогноза. При ведении пациентов с ССД необходимо обращать внимание на повышенный риск кровотечений из ЖКТ, особенно при наличии коморбидности (сахарный диабет, гипертоническая болезнь, фибрилляция предсердий), требующей дополнительного применения вазодилататоров, антикоагулянтов. Следует рассмотреть возможность использования эндоскопического мониторинга желудочно-кишечных осложнений у пациентов с ССД, особенно имеющих дополнительные факторы риска поражения верхних отделов ЖКТ, что позволит проводить надлежащую оценку риска кровотечения и может обеспечить своевременное принятие профилактических мер.

Systemic sclerosis (SS) is a disease with diverse clinical manifestations, with common damage of the gastrointestinal tract (GIT). The traditional description of GIT disorders includes the development of strictures of the lower third of the esophagus due to its scarring with recurrent ulcerative lesions, gastric bleeding due to telangiectasis of the gastric mucosa or ulcerative defects due to ischemia and drug therapy. The development of GIT bleeding is a life-threatening complication of SS. The causes of gastrointestinal bleeding in this category of patients may be both abnormalities of the gastrointestinal mucosa associated with the manifestations of the disease, as well as the effect of basic drug therapy, as well as the presence and treatment of concomitant diseases. In this aspect, early diagnosis of mucosal changes from the digestive tract is a key point in choosing methods for patients monitoring to determine the best tactics of drug therapy, taking into account the benefit/risk ratio while achieving symptom control with improved prognosis. Doctors treating patients with SS should pay attention to the increased risk of gastrointestinal bleeding, especially among patients with comorbid vascular pathology (diabetes mellitus, hypertension, atrial fibrillation), requiring additional use of vasodilators, anticoagulants. Consideration should be given to the endoscopic monitoring of GIT complications among patients with SS, especially those with additional risk factors for damage to the upper GIT, which will useful an appropriate assessment of the risk of bleeding and may ensure timely preventive measures.

системная склеродермияпоражение желудочно-кишечного трактажелудочно-кишечное кровотечениеsystemic sclerosisgastrointestinal tract damagegastrointestinal bleedingReferencesJohannes WJ Bijlsma. EULAR Texbook on Systemic Sclerosis. 2nd ed. Hachulla E, editor. London: BMJ, 2019. Сriteria for the classification of systemic sclerosis (scleroderma). Subcommittee for scleroderma criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee. Arthritis Rheum. 1980; 23: 581–590. https://doi.org/10.1002/art.1780230510Johannes WJ Bijlsma. EULAR Texbook on Systemic Sclerosis. 2nd ed. Hachulla E, editor. London: BMJ, 2019. Сriteria for the classification of systemic sclerosis (scleroderma). Subcommittee for scleroderma criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee. Arthritis Rheum. 1980; 23: 581–590. https://doi.org/10.1002/art.1780230510Volkmann ER, Varga J. Emerging targets of disease-modifying therapy for systemic sclerosis. Nat Rev Rheumatol. 2019; 15 (4): 208–24. https://doi.org/10.1038/s41584-019-0184-zVolkmann ER, Varga J. Emerging targets of disease-modifying therapy for systemic sclerosis. Nat Rev Rheumatol. 2019; 15 (4): 208–24. https://doi.org/10.1038/s41584-019-0184-zAsano Y. Systemic sclerosis. J Dermatol. 2018; 45 (2): 128–38. https://doi.org/10.1111/1346-8138.14153Asano Y. Systemic sclerosis. J Dermatol. 2018; 45 (2): 128–38. https://doi.org/10.1111/1346-8138.14153Kuo CF, See LC, Yu KH, Chou IJ, Tseng WY, Chang HC. et al. Epidemiology and mortality of systemic sclerosis: a nationwide population study in Taiwan. Scand J Rheumatol. 2011; 40 (5): 373–8. https://doi.org/10.3109/03009742.2011.553736Kuo CF, See LC, Yu KH, Chou IJ, Tseng WY, Chang HC. et al. Epidemiology and mortality of systemic sclerosis: a nationwide population study in Taiwan. Scand J Rheumatol. 2011; 40 (5): 373–8. https://doi.org/10.3109/03009742.2011.553736Rosa JE, Soriano ER, Narvaez-Ponce L, del Cid CC, Imamura PM, Catoggio LJ. Incidence and prevalence of systemic sclerosis in a healthcare plan in Buenos Aires. J Clin Rheumatol. 2011; 17 (2): 59–63. https://doi.org/10.1097/rhu.0b013e31820e7e8dRosa JE, Soriano ER, Narvaez-Ponce L, del Cid CC, Imamura PM, Catoggio LJ. Incidence and prevalence of systemic sclerosis in a healthcare plan in Buenos Aires. J Clin Rheumatol. 2011; 17 (2): 59–63. https://doi.org/10.1097/rhu.0b013e31820e7e8dMcMahan ZH. Gastrointestinal involvement in systemic sclerosis: an update. Curr Opin Rheumatol. 2019; 31: 561–568. https://doi.org/10.1097/bor.0000000000000645McMahan ZH. Gastrointestinal involvement in systemic sclerosis: an update. Curr Opin Rheumatol. 2019; 31: 561–568. https://doi.org/10.1097/bor.0000000000000645Miller JB, Gandhi N, Clarke J, McMahan Z. Gastrointestinal Involvement in Systemic Sclerosis: An Update. J Clin Rheumatol. 2018; 24: 328–337. https://doi.org/10.1097/rhu.0000000000000626Miller JB, Gandhi N, Clarke J, McMahan Z. Gastrointestinal Involvement in Systemic Sclerosis: An Update. J Clin Rheumatol. 2018; 24: 328–337. https://doi.org/10.1097/rhu.0000000000000626Iglesias-Gamarra A, Jaramillo-Arroyave D, Quintana G, Rondon-Herrera F, Matucci-Cerinic M. Historia del compromiso cutáneo de la esclerosis sistémica. Rev Colomb Reumatol. 2013; 20: 155–170. https://doi.org/10.1016/s0121-8123(13)70128-2Iglesias-Gamarra A, Jaramillo-Arroyave D, Quintana G, Rondon-Herrera F, Matucci-Cerinic M. Historia del compromiso cutáneo de la esclerosis sistémica. Rev Colomb Reumatol. 2013; 20: 155–170. https://doi.org/10.1016/s0121-8123(13)70128-2Tyndall AJ, Bannert B, Vonk M, Airo P, Cozzi F, Carreira PE. et al. Causes and risk factors for death in systemic sclerosis: a study from the EULAR Scleroderma Trials and Research (EUSTAR) database. Ann Rheum Dis. 2010; 69 (10): 1809–15. https://doi.org/10.1136/ard.2009.114264Tyndall AJ, Bannert B, Vonk M, Airo P, Cozzi F, Carreira PE. et al. Causes and risk factors for death in systemic sclerosis: a study from the EULAR Scleroderma Trials and Research (EUSTAR) database. Ann Rheum Dis. 2010; 69 (10): 1809–15. https://doi.org/10.1136/ard.2009.114264Duchini A, Sessoms SL. Gastrointestinal hemorrhage in patients with systemic sclerosis and CREST syndrome. Am J Gastroenterol. 1998; 93 (9): 1453–6. https://doi.org/10.1111/j.1572-0241.1998.00462.xDuchini A, Sessoms SL. Gastrointestinal hemorrhage in patients with systemic sclerosis and CREST syndrome. Am J Gastroenterol. 1998; 93 (9): 1453–6. https://doi.org/10.1111/j.1572-0241.1998.00462.xPlastiras SC, Tzivras M, Vlachoyiannopoulos PG. Severe gastrointestinal involvement in systemic sclerosis. Clin Rheumatol. 2007; 26 (6): 1025–6. https://doi.org/10.1007/s10067-006-0264-8Plastiras SC, Tzivras M, Vlachoyiannopoulos PG. Severe gastrointestinal involvement in systemic sclerosis. Clin Rheumatol. 2007; 26 (6): 1025–6. https://doi.org/10.1007/s10067-006-0264-8Ebert EC. Gastric and enteric involvement in progressive systemic sclerosis. J Clin Gastroenterol. 2008; 42 (1): 5–12. https://doi.org/10.1097/mcg.0b013e318042d625Ebert EC. Gastric and enteric involvement in progressive systemic sclerosis. J Clin Gastroenterol. 2008; 42 (1): 5–12. https://doi.org/10.1097/mcg.0b013e318042d625Marie I, Antonietti M, Houivet E, Hachulla E, Maunoury V, Bienvenu B, Viennot S, Smail A, Duhaut P, Dupas JL, Dominique S, Hatron PY, Levesque H, Benichou J, Ducrotté P. Gastrointestinal mucosal abnormalities using videocapsule endoscopy in systemic sclerosis. Aliment Pharmacol Ther. 2014; 40: 189–199. https://doi.org/10.1111/apt.12818Marie I, Antonietti M, Houivet E, Hachulla E, Maunoury V, Bienvenu B, Viennot S, Smail A, Duhaut P, Dupas JL, Dominique S, Hatron PY, Levesque H, Benichou J, Ducrotté P. Gastrointestinal mucosal abnormalities using videocapsule endoscopy in systemic sclerosis. Aliment Pharmacol Ther. 2014; 40: 189–199. https://doi.org/10.1111/apt.12818Lin YT, Chuang YS, Wang JW, Wu PH. High risk of gastrointestinal hemorrhage in patients with systemic sclerosis. Arthritis Res Ther. 2019; 21: 301. https://doi.org/10.1186/s13075-019-2078-5Lin YT, Chuang YS, Wang JW, Wu PH. High risk of gastrointestinal hemorrhage in patients with systemic sclerosis. Arthritis Res Ther. 2019; 21: 301. https://doi.org/10.1186/s13075-019-2078-5Wielosz E, Borys O, Zychowska I, Majdan M. Gastrointestinal involvement in patients with systemic sclerosis. Polskie Archiwum Medycyny Wewnetrznej. 2010; 120 (4): 132–6. https://doi.org/10.20452/pamw.907Wielosz E, Borys O, Zychowska I, Majdan M. Gastrointestinal involvement in patients with systemic sclerosis. Polskie Archiwum Medycyny Wewnetrznej. 2010; 120 (4): 132–6. https://doi.org/10.20452/pamw.907Ebert EC. Esophageal disease in scleroderma. J Clin Gastroenterol. 2006; 40 (9): 769–75. https://doi.org/10.1097/01.mcg.0000225549.19127.90Ebert EC. Esophageal disease in scleroderma. J Clin Gastroenterol. 2006; 40 (9): 769–75. https://doi.org/10.1097/01.mcg.0000225549.19127.90Szamosi S, Szekanecz Z, Szucs G. Gastrointestinal manifestations in Hungarian scleroderma patients. Rheumatol Int. 2006; 26 (12): 1120–4. https://doi.org/10.1007/s00296–006–0146-zSzamosi S, Szekanecz Z, Szucs G. Gastrointestinal manifestations in Hungarian scleroderma patients. Rheumatol Int. 2006; 26 (12): 1120–4. https://doi.org/10.1007/s00296–006–0146-zNtoumazios SK, Voulgari PV, Potsis K, Koutis E, Tsifetaki N, Assimakopoulos DA. Esophageal involvement in scleroderma: gastroesophageal reflux, the common problem. Semin Arthritis Rheum. 2006; 36 (3): 173–81. https://doi.org/10.1016/j.semarthrit.2006.08.002Ntoumazios SK, Voulgari PV, Potsis K, Koutis E, Tsifetaki N, Assimakopoulos DA. Esophageal involvement in scleroderma: gastroesophageal reflux, the common problem. Semin Arthritis Rheum. 2006; 36 (3): 173–81. https://doi.org/10.1016/j.semarthrit.2006.08.002Marie I, Levesque H, Ducrotte P, Denis P, Hellot MF, Benichou J. et al. Gastric involvement in systemic sclerosis: a prospective study. Am J Gastroenterol. 2001; 96 (1): 77–83. https://doi.org/10.1111/j.1572-0241.2001.03353.xMarie I, Levesque H, Ducrotte P, Denis P, Hellot MF, Benichou J. et al. Gastric involvement in systemic sclerosis: a prospective study. Am J Gastroenterol. 2001; 96 (1): 77–83. https://doi.org/10.1111/j.1572-0241.2001.03353.xMcFarlane IM, Bhamra MS, Kreps A, Iqbal S, Al-Ani F, Saladini-Aponte C, et al. Gastrointestinal manifestations of systemic sclerosis. Rheumatology (Sunnyvale). 2018; 8 (1). https://doi.org/10.4172/2161-1149.1000235McFarlane IM, Bhamra MS, Kreps A, Iqbal S, Al-Ani F, Saladini-Aponte C, et al. Gastrointestinal manifestations of systemic sclerosis. Rheumatology (Sunnyvale). 2018; 8 (1). https://doi.org/10.4172/2161-1149.1000235Varga J, Trojanowska M, Kuwana M. Pathogenesis of systemic sclerosis: recent insights of molecular and cellular mechanisms and therapeutic opportunities. J Scleroderma Relat Disord. 2017; 2: 137–152. https://doi.org/10.5301/jsrd.5000249Varga J, Trojanowska M, Kuwana M. Pathogenesis of systemic sclerosis: recent insights of molecular and cellular mechanisms and therapeutic opportunities. J Scleroderma Relat Disord. 2017; 2: 137–152. https://doi.org/10.5301/jsrd.5000249Parrado RH, Lemus HN, Coral-Alvarado PX, Quintana López G. Gastric Antral Vascular Ectasia in Systemic Sclerosis: Current Concepts. Int J Rheumatol. 2015; 2015: 762546. https://doi.org/10.1155/2015/762546Parrado RH, Lemus HN, Coral-Alvarado PX, Quintana López G. Gastric Antral Vascular Ectasia in Systemic Sclerosis: Current Concepts. Int J Rheumatol. 2015; 2015: 762546. https://doi.org/10.1155/2015/762546Ingraham KM, O'Brien MS, Shenin M, Derk CT, Steen VD. Gastric antral vascular ectasia in systemic sclerosis: demographics and disease predictors. J Rheumatol. 2010; 37: 603–607. https://doi.org/10.3899/jrheum.090600Ingraham KM, O'Brien MS, Shenin M, Derk CT, Steen VD. Gastric antral vascular ectasia in systemic sclerosis: demographics and disease predictors. J Rheumatol. 2010; 37: 603–607. https://doi.org/10.3899/jrheum.090600Marie I, Ducrotte P, Antonietti M, Herve S, Levesque H. Watermelon stomach in systemic sclerosis: its incidence and management. Aliment Pharmacol Ther. 2008; 28: 412–421. https://doi.org/10.1111/j.1365-2036.2008.03739.xMarie I, Ducrotte P, Antonietti M, Herve S, Levesque H. Watermelon stomach in systemic sclerosis: its incidence and management. Aliment Pharmacol Ther. 2008; 28: 412–421. https://doi.org/10.1111/j.1365-2036.2008.03739.xAssad APL, Farias R, Gaspari CN, da Silva HC, Andrade DCO, Sampaio-Barros PD. Diagnosis and Management of Gastric Antral Vascular Ectasia: Experience in a Larg Single Cohort of Patients with Systemic Sclerosis. J Clin Rheumatol. 2020; 26: 79–81. https://doi.org/10.1097/rhu.0000000000000927Assad APL, Farias R, Gaspari CN, da Silva HC, Andrade DCO, Sampaio-Barros PD. Diagnosis and Management of Gastric Antral Vascular Ectasia: Experience in a Larg Single Cohort of Patients with Systemic Sclerosis. J Clin Rheumatol. 2020; 26: 79–81. https://doi.org/10.1097/rhu.0000000000000927Kumar S, Singh J, Rattan S, DiMarino AJ, Cohen S, Jimenez SA. Review article: pathogenesis and clinical manifestations of gastrointestinal involvement in systemic sclerosis. Aliment Pharmacol Ther. 2017; 45: 883–898. https://doi.org/10.1111/apt.13963Kumar S, Singh J, Rattan S, DiMarino AJ, Cohen S, Jimenez SA. Review article: pathogenesis and clinical manifestations of gastrointestinal involvement in systemic sclerosis. Aliment Pharmacol Ther. 2017; 45: 883–898. https://doi.org/10.1111/apt.13963Shibukawa G, Irisawa A, Sakamoto N, Takagi T, Wakatsuki T, Imamura H, Takahashi Y, Sato A, Sato M, Hikichi T, Obara K, Ohira H. Gastric antral vascular ectasia (GAVE) associated with systemic sclerosis: relapse after endoscopic treatment by argon plasma coagulation. Intern Med. 2007; 46: 279–283. https://doi.org/10.2169/internalmedicine.46.6203Shibukawa G, Irisawa A, Sakamoto N, Takagi T, Wakatsuki T, Imamura H, Takahashi Y, Sato A, Sato M, Hikichi T, Obara K, Ohira H. Gastric antral vascular ectasia (GAVE) associated with systemic sclerosis: relapse after endoscopic treatment by argon plasma coagulation. Intern Med. 2007; 46: 279–283. https://doi.org/10.2169/internalmedicine.46.6203McCarty TR, Rustagi T. Comparative Effectiveness and Safety of Radiofrequency Ablation versus Argon Plasma Coagulation for Treatment of Gastric Antral Vascular Ectasia: A Systematic Review and Meta-Analysis. J Clin Gastroenterol. 2019; 53: 599–606. https://doi.org/10.1097/mcg.0000000000001088McCarty TR, Rustagi T. Comparative Effectiveness and Safety of Radiofrequency Ablation versus Argon Plasma Coagulation for Treatment of Gastric Antral Vascular Ectasia: A Systematic Review and Meta-Analysis. J Clin Gastroenterol. 2019; 53: 599–606. https://doi.org/10.1097/mcg.0000000000001088Kirby DF, Chatterjee S. Evaluation and management of gastrointestinal manifestations in scleroderma. Curr Opin Rheumatol. 2014; 26: 621–629. https://doi.org/10.1097/bor.0000000000000117Kirby DF, Chatterjee S. Evaluation and management of gastrointestinal manifestations in scleroderma. Curr Opin Rheumatol. 2014; 26: 621–629. https://doi.org/10.1097/bor.0000000000000117Ананьева Л. П. Лечение системной склеродермии с учетом национальных рекомендаций и рекомендаций Европейской лиги по борьбе с ревматизмом (EULAR). Фарматека. 2014; 10: 79–86. EDN SLSVGP.Ananyeva L. P. Treatment of systemic scleroderma based on national recommendations and recommendations of the European League against Rheumatism (EULAR). Pharmaceutical library. 2014; 10: 79–86. EDN SLSVGP.Приказ 203-н Минздрава России от 10.05.2017 N 203н «Об утверждении критериев оценки качества медицинской помощи» (зарегистрировано в Минюсте России 17.05.2017, N 46740).Order 203-n of the Ministry of Health of Russia dated 05/10/2017 N203n «On approval of criteria for assessing the quality of medical care» (registered with the Ministry of Justice of Russia on 05/17/2017, N 46740).Emmanuel A. Current management of the gastrointestinal complications of systemic sclerosis. Nat Rev Gastroenterol Hepatol. 2016; 13: 461–472. https://doi.org/10.1038/nrgastro.2016.99Emmanuel A. Current management of the gastrointestinal complications of systemic sclerosis. Nat Rev Gastroenterol Hepatol. 2016; 13: 461–472. https://doi.org/10.1038/nrgastro.2016.99Walker UA, Tyndall A, Czirják L, Denton C, Farge-Bancel D, Kowal-Bielecka O, Müller-Ladner U, Bocelli-Tyndall C, Matucci-Cerinic M. Clinical risk assessment of organ manifestations in systemic sclerosis: a report from the EULAR Scleroderma Trials and Research group database. Ann Rheum Dis. 2007; 66: 754–763. https://doi.org/10.1136/ard.2006.062901Walker UA, Tyndall A, Czirják L, Denton C, Farge-Bancel D, Kowal-Bielecka O, Müller-Ladner U, Bocelli-Tyndall C, Matucci-Cerinic M. Clinical risk assessment of organ manifestations in systemic sclerosis: a report from the EULAR Scleroderma Trials and Research group database. Ann Rheum Dis. 2007; 66: 754–763. https://doi.org/10.1136/ard.2006.062901Алговер-Бурри (1967) цит. по Климанскому В. А. и Рудаеву А. Я. Трансфузионная терапия при хирургических заболеваниях. М., 1984. С. 255.Algover-Burri (1967) cited in Limansky V. A. and Rudaev A. Ya. Transfusion therapy in surgical diseases. Moscow, 1984. P. 255.

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