clinmedКлиническая медицинаClinical Medicine (Russian Journal)0023-21492412-1339ООО «Медицинское информационное агентство»10.30629/0023-2149-2023-101-2-3-141-146clinmed-517Research ArticleВ ПОМОЩЬ ПРАКТИЧЕСКОМУ ВРАЧУGUIDELINES FOR PRACTITIONERSСовременные подходы к ведению больных остеоартритом в реальной клинической практикеModern approaches to the management of patients with osteoarthritis in real clinical practicehttps://orcid.org/0000-0002-6068-3080ЛилаА. М.LilaA. M.

Лила Александр Михайлович — д-р мед. наук, профессор, член-корр. РАН, директор; зав. кафедрой ревматологии 

115522, Москва

125993, Москва

Lila Alexander M.

115522, Moscow

125993, Moscow

https://orcid.org/0000-0001-7017-0898АлексееваЛ. И.AlekseevaL. I.

Алексеева Людмила Ивановна — д-р мед. наук, начальник отдела метаболических заболеваний костей и суставов; профессор кафедры ревматологии

115522, Москва

125993, Москва

Alekseeva Lyudmila I.

115522, Moscow

125993, Moscow

dr.alekseeva@gmail.comФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»; ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияV.A. Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuous Professional Education of the Ministry of Health of RussiaRussian Federation2023130420231012-3141146Copyright © Лила А.М., Алексеева Л.И., 20232023Лила А.М., Алексеева Л.И.Lila A.M., Alekseeva L.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.clinmedjournal.com/jour/article/view/517

Остеоартрит (ОА) представляет из себя гетерогенное заболевание, в основе которого лежит низкоинтенсивное воспаление, затрагивающее все ткани сустава и позволяющее рассматривать его как органную патологию, то есть болезнь целого органа — сустава. В статье представлены алгоритмы ведения больного с ОА, включающие немедикаментозные, фармакологические и хирургические вмешательства. Медикаментозное лечение состоит из трех этапов последовательного назначения лекарственных средств. Подчеркнуто раннее применение симптоматических средств замедленного действия, способствующих повышению эффективности лечения, позволяющих снизить боль, улучшить функцию суставов и тем самым повысить качество жизни больных.

Osteoarthritis (OA) is a heterogeneous condition, which is based on low-intensity infl ammation that aff ects all tissues of the joint, and allows it to be considered as an organ pathology, that is, a disease of the whole organ — the joint. The article presents algorithms for managing a patient with OA, including non-drug, pharmacological treatment and surgical interventions. Drug treatment consists of three stages of sequential prescription of medications. The early use of symptomatic slow-acting drugs in osteoarthritis (SYSADOA) is emphasized. It increases the eff ectiveness of treatment, reduces pain, improves joint function, and thereby improves the quality of life of patients.

остеоартриталгоритмы лечениярекомендациисимптоматические средства замедленного действияosteoarthritistreatment algorithmsrecommendationssymptomatic slow acting drags of osteoarthritisReferencesSellam J., Berenbaum F. The role of synovitis in pathophysiology and clinical symptoms of osteoarthritis. Nat. Rev. Rheumatol. 2010;6:625–635.Sellam J., Berenbaum F. The role of synovitis in pathophysiology and clinical symptoms of osteoarthritis. Nat. Rev. Rheumatol. 2010;6:625–635.Hasegawa A., Otsuki S., Pauli C. et al. Anterior cruciate ligament changes in the human knee joint in aging and osteoarthritis. Arthritis Rheum. 2012;64:696–704.Hasegawa A., Otsuki S., Pauli C. et al. Anterior cruciate ligament changes in the human knee joint in aging and osteoarthritis. Arthritis Rheum. 2012;64:696–704.Burr D.B., Gallant M.A. Bone remodelling in osteoarthritis. Nat. Rev. Rheumatol. 2012;8:665–673.Burr D.B., Gallant M.A. Bone remodelling in osteoarthritis. Nat. Rev. Rheumatol. 2012;8:665–673.Neogi T. Clinical signifi cance of bone changes in osteoarthritis. Ther. Adv. Musculoskelet. Dis. 2012;4:259–267.Neogi T. Clinical signifi cance of bone changes in osteoarthritis. Ther. Adv. Musculoskelet. Dis. 2012;4:259–267.Bijlsma J., Berenbaum F., Lafeber P. Osteoarthritis: an update with relevance for clinicaдpractice. Lancet. 2011;377(9783):2115–26. DOI: 10.1016/S0140-6736(11)60243-2Bijlsma J., Berenbaum F., Lafeber P. Osteoarthritis: an update with relevance for clinicaдpractice. Lancet. 2011;377(9783):2115–26. DOI: 10.1016/S0140-6736(11)60243-2Кашеварова Н.Г., Алексеева Л.И., Аникин С.Г., Демин Н.В., Смирнов А.В., Насонов Е.Л. Остеоартроз коленных суставов: факторы риска прогрессирования заболевания суставов при пятилетнем проспективном заболевании. Материалы III Евразийского конгресса ревматологов (Минск, Республика Беларусь, 26–27 мая 2016 г.). Вопросы организации и информатизации здравоохранения. Аналитико-информационный бюллетень. 2016:144–149).Kashevarova N.G., Alekseeva L.I., Anikin S.G., Demin N.V., Smirnov A.V., Nasonov E.L. Osteoarthritis of the knee joints: risk factors for the progression of joint disease in a fi ve-year prospective disease. Proceedings of the III Eurasian Congress of Rheumatologists (Minsk, Republic of Belarus, May 26–27, 2016). Issues of organization and informatization of health care. Analytical Information Bulletin. 2016:44–149. (In Russian)].Bruyère O., Cooper C., Pelletier J.-P., Branko J., Brandy M.L. et al. An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: A report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Seminars in Arthritis and Rheumatism. 2014:2–11.Bruyère O., Cooper C., Pelletier J.-P., Branko J., Brandy M.L. et al. An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: A report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Seminars in Arthritis and Rheumatism. 2014:2–11.Greenen R., Overman C., Christensen R. et al. EULAR recommendations for the health professionals’ approach to pain management in infl ammatory arthritis and osteoarthritis. Ann. Rheum. Dis. 2018;77:797–807. DOI: 10.1136/annrheumdis-2017-212662Greenen R., Overman C., Christensen R. et al. EULAR recommendations for the health professionals’ approach to pain management in infl ammatory arthritis and osteoarthritis. Ann. Rheum. Dis. 2018;77:797–807. DOI: 10.1136/annrheumdis-2017-212662Hochberg M.C., Martel-Pelletier J., Monfort J. et al. Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib. Ann. Rheum. Dis. 2016;75:37–44.Hochberg M.C., Martel-Pelletier J., Monfort J. et al. Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib. Ann. Rheum. Dis. 2016;75:37–44.Pelletier J., Raynauld J., Paiement P., Dorais M., Martel-Pelletier J. In an International, Multicentre, Double-blind, Randomised Study in Knee Osteoarthritis Patients, Diacerein Was Found as Eff ective as Celecoxib in Reducing Pain and Disease Symptoms [abstract]. Arthritis Rheumatol. 2019;71(10). ACR 2019.Pelletier J., Raynauld J., Paiement P., Dorais M., Martel-Pelletier J. In an International, Multicentre, Double-blind, Randomised Study in Knee Osteoarthritis Patients, Diacerein Was Found as Eff ective as Celecoxib in Reducing Pain and Disease Symptoms [abstract]. Arthritis Rheumatol. 2019;71(10). ACR 2019.Lee Y.H. Chondroitin sulfate is superior to placebo in symptomatic kneeosteoarthritis. Ann. Rheum. Dis. 2018;77(8):e54. DOI: 10.1136/annrheumdis-2017-212452.Lee Y.H. Chondroitin sulfate is superior to placebo in symptomatic kneeosteoarthritis. Ann. Rheum. Dis. 2018;77(8):e54. DOI: 10.1136/annrheumdis-2017-212452.Zhu X., Wu D., San L., Wan Y., She Y., Zhuan X. et al. Comparative eff ectiveness of glucosamine, chondroitin, acetaminophen or celecoxib for the treatment of knee and/or hip osteoarthritis: a network metaanalysis. Clinical and Experimental Rheumatology. 2018;36:595–602.Zhu X., Wu D., San L., Wan Y., She Y., Zhuan X. et al. Comparative eff ectiveness of glucosamine, chondroitin, acetaminophen or celecoxib for the treatment of knee and/or hip osteoarthritis: a network metaanalysis. Clinical and Experimental Rheumatology. 2018;36:595–602.Yang W., Sun C., He S.Q. et al. The Effi cacy and Safety of DiseaseModifying Osteoarthritis Drugs for Knee andHip Osteoarthritis – a Systematic Review and Network Meta-Analysis. J. Gen. Intern. Med. 2021;36(7):2085–2093. DOI: 10.1007/s11606-021-06755-zYang W., Sun C., He S.Q. et al. The Effi cacy and Safety of DiseaseModifying Osteoarthritis Drugs for Knee andHip Osteoarthritis – a Systematic Review and Network Meta-Analysis. J. Gen. Intern. Med. 2021;36(7):2085–2093. DOI: 10.1007/s11606-021-06755-zHonvo G., Reginster J.-Y., Rabenda V., Geerinck A., Mkinsi O., Charles A. et al. Safety of symptomatic slow-acting drugs for osteoarthritis: outcomes of a systematic review and meta-analysis. Drugs Aging. 2019;36(1). DOI: 10.1007/s4026 6-019-00662-zHonvo G., Reginster J.-Y., Rabenda V., Geerinck A., Mkinsi O., Charles A. et al. Safety of symptomatic slow-acting drugs for osteoarthritis: outcomes of a systematic review and meta-analysis. Drugs Aging. 2019;36(1). DOI: 10.1007/s4026 6-019-00662-zConaghan P.G., Arden N., Avouac B., Migliore A., Rizzoli R. Safety of paracetamol: what does the literature say? Drugs Aging. 2019;36(1). DOI: 10.1007/s40266-019-00658-9Conaghan P.G., Arden N., Avouac B., Migliore A., Rizzoli R. Safety of paracetamol: what does the literature say? Drugs Aging. 2019;36(1). DOI: 10.1007/s40266-019-00658-9Wolff D.G., Christophersen C., Brown S.M., Mulcahey M.K. Topical nonsteroidal anti-infl ammatory drugs in the treatment of knee ost eoarthritis: a systematic review and meta-analysis. Phys. Sportsmed. 2021;49(4):381–391. DOI: 10.1080/00913847.2021.1886573Wolff D.G., Christophersen C., Brown S.M., Mulcahey M.K. Topical nonsteroidal anti-infl ammatory drugs in the treatment of knee ost eoarthritis: a systematic review and meta-analysis. Phys. Sportsmed. 2021;49(4):381–391. DOI: 10.1080/00913847.2021.1886573Coxib and traditional NSAID Trialists’ (CNT) Collaboration: Bhala N., Emberson J., Merhi A., Abramson S., Arber N. et al. Vascular and upper gastrointestinal eff ects of non-steroidal antiinfl ammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet. 2013;382:769–79.Coxib and traditional NSAID Trialists’ (CNT) Collaboration: Bhala N., Emberson J., Merhi A., Abramson S., Arber N. et al. Vascular and upper gastrointestinal eff ects of non-steroidal antiinfl ammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet. 2013;382:769–79.Каратеев А.Е., Насонов Е.Л., Ивашкин В.Т., Мартынов А.И., Яхно Н.Н., Арутюнов Г.П. и др. Рациональное использование нестероидных противовоспалительных препаратов. Клинические рекомендации. Научно-практическая ревматология. 2018;56:1–29. DOI: 10.14412/1995-4484-2018-1-29Karateev A.E., Nasonov E.L., Ivashkin V.T., Martynov A.I., Yakhno N.N., Arutyunov G.P. et al. Rational use of non-steroid anti-infl ammatory drugs. Clinical recommendations. Scientifi c and practical rheumatology. 2018;56:1–29. (In Russian)]. DOI: 10.14412/1995-4484-2018-1-29Honvo G., Reginster J.Y., Rannou F., Rygaert X., Geerinck A., Rabenda V. et al. Safety of intra-articular hyaluronic acid injections in osteoarthritis: outcomes of a systematic review and metaanalysis. Drugs Aging. 2019;36(1). DOI: 10.1007/s40266-019-00657-wHonvo G., Reginster J.Y., Rannou F., Rygaert X., Geerinck A., Rabenda V. et al. Safety of intra-articular hyaluronic acid injections in osteoarthritis: outcomes of a systematic review and metaanalysis. Drugs Aging. 2019;36(1). DOI: 10.1007/s40266-019-00657-wFuggle N., Curtis E., Shaw S., Spooner L., Bruyere O., Ntani G. et al. Safety of opioids in osteoarthritis: outcomes of a systematic review and meta-analysis. Drugs Aging. 2019;36(1). DOI: 10.1007/s40266-019-00666-9Fuggle N., Curtis E., Shaw S., Spooner L., Bruyere O., Ntani G. et al. Safety of opioids in osteoarthritis: outcomes of a systematic review and meta-analysis. Drugs Aging. 2019;36(1). DOI: 10.1007/s40266-019-00666-9

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