rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2012-1179rsp-1093Research ArticleСтатьиArticlesФЕНОМЕН МИКРОКРИСТАЛЛИЗАЦИИ ХРЯЩА ПРИ КОКСАРТРОЗЕ И АСЕПТИЧЕСКОМ НЕКРОЗЕ ГОЛОВКИ БЕДРЕННОЙ КОСТИCARTILLAGE MICROCRYSTALLIZATION PHENOMENON IN COXARTHROSIS AND AVASCULAR NECROSIS OF FEMORAL HEADДубиковА. И.DubikovA I-KabalykMaksim AlexandrovichKabalykMaksim Alexandrovichmaxi_maxim@mail.ruPetrikeevaT YuPetrikeevaT Yu-KuzminI IKuzminI I-KorabtsovA AKorabtsovA A-201215102012505№5 (2012)3741Copyright © Дубиков А.И., Kabalyk M.A., Petrikeeva T.Y., Kuzmin I.I., Korabtsov A.A., 20122012Дубиков А.И., Kabalyk M.A., Petrikeeva T.Y., Kuzmin I.I., Korabtsov A.A.Dubikov A.I., Kabalyk M.A., Petrikeeva T.Y., Kuzmin I.I., Korabtsov A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/1093

Остеоартроз (ОА) является наиболее распространенной патологией в ревматологической практике. Среди всех теорий патогенеза этого заболевания особое положение занимает концепция отложения кальцийсодержащих кристаллов в суставном хряще и параартикулярных тканях. Цель — изучение феномена микрокристаллизации суставного хряща у больных ОА и с асептическим некрозом головки бедренной кости (АНГБК) с помощью рентгеновского структурного анализа. Материал и методы. В исследование были включены 80 человек, которым проводилось тотальное эндопротезирование по поводу коксартроза или АНГБК. В качестве контроля набрана группа из 20 пациентов с тотальным эндопротезированием тазобедренного сустава по поводу переломов шейки бедренной кости. Исследование на наличие кристаллов проводили с помощью рентгеновского дифрактометра, растрового электронного микроскопа. Результаты. Феномен минерализации хряща встречается в 92% случаев у больных ОА поздних стадий и у всех больных с АНГБК. Анализ показал преобладающее значение кристаллов основного фосфата кальция. Рентгеновская дифракция может быть использована в практических и научных целях.

Osteoarthritis (OA) is the most prevalent pathology in routine rheumatologic practice. The concept of calcium-containing crystals deposition within articular cartilage and paraarticular tissues remains the centerpiece among existing theories on the pathogenesis of OA. Objective — radiographic structural analysis of articular cartilage microcrystallization phenomenon in patients with OA and avascular necrosis of femoral head (ANFH). Material and methods. Overall 80 patients after total hip replacement procedure due to coxarthrosis or ANFH were enrolled into this study. The control group included 20 patients with total hip arthroplasty for femoral neck fractures. X-ray diffractometer and scanning electron microscope were used to detect crystal deposition. Results. Cartilage mineralization was observed in 92% of patients with advanced OA and in 100% of ANFH patients. The analysis revealed predominance of calcium phosphate monobasic crystals. X-ray diffraction can be used for practical and investigational purposes.

остеоартрозхондрокальцинозасептический некроз головки бедренной костипирофосфат кальцияосновной фосфат кальциямикрокристаллические артропатииosteoarthritischondrocalcinosisavascular necrosis of the femoral headcalcium pyrophosphatecalcium phosphate monobasicmicrocrystalline arthropathiesReferences<div><p>Насонов Е.Л. Ревматология: Национальное руководство. М.: ГЭОТАР-Медиа, 2011; 99—110.</p><p>Arden N., Nevitt M.C. Osteoarthritis: epidemiology. Best Pract Res Clin Rheumatol 2006; 20: 3-25.</p><p>Ryan L.M., McCarthy D.J. Calcium pyrophosphate crystal deposition disease, pseudogout and articular chondrocalcinosis. In: Arthritis and allied conditions. Ed. by W.J. Koopman. Baltimore: Wiliams &amp; Wilkins, 1997: 2103—5.</p><p>Derfus B.A., Kurian J.B., Butler J.J. et al. The high prevalence of pathologic calcium crystals in pre-operative knees. J Rheumatol 2002; 29(3): 570—4.</p><p>Halverson P.B., McCarty D.J. Patterns of radiographic abnormalities associated with basic calcium phosphate and calcium pyrophosphate dihydrate crystal deposition in the knee. Ann Rheum Dis 1986; 45(7): 603—5.</p><p>Sokoloff L., Varma A.A. Chondrocalcinosis in surgically resected joints. Arthr Rheum 1988; 31(6): 750—6.</p><p>Abreu M., Johnson K., Chung C.B. et al. Calcification in calcium pyrophosphate dihydrate (CPPD) cristalline deposits in the knee: anatomic, radiographic, MR imaging, and histologic study in cadavers. Skeletal Radiol 2004; 33(7): 392—8.</p><p>Mitrovic D.R., Stankovic A., Iriarte-Borda O. et al. The prevalence of chondrocalcinosis in the human knee joint. An autopsy survey. J Rheumatol 1988; 15(4): 633—41.</p><p>Ishikawa K., Masuda I., Ohira T., Yokoyama M. A histological study of calcium pyrophosphate dihydrate crystal-deposition disease. J Bone Joint Surg Am 1989; 71(6): 875—86.</p><p>Ea H.K., Nguyen C., Bazin D. et al. Articular cartilage calcification in osteoarthritis: insights into crystal-induced stress. Arthr Rheum 2011; 63(1): 10—8.</p><p>Rajpura A., Wright A.C., Board T.N. Medical management of osteonecrosis of the hip: a review. Hip Int 2011; 21(4): 385—92.</p><p>Watt I., Dieppe P.A. Medial femoral condyle necrosis and chondrocalcinosis — a causal relationship? Br J Radiol 1983; 56(661): 7—11.</p><p>Насонов Е.Л. Ревматология: Клинические рекомендации. М.: ГЭОТАР-Медиа, 2011; 99—110.</p><p>Altman R., Alarcon G., Appelrouth D. et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthr Rheum 1991; 34: 505-14.</p><p>Kellgren J.H., Lawrence J.S. Radiological assessment of osteoarthrosis. Ann Rheum Dis 1957; 16(4): 494—502.</p><p>Harris W.H. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969; 51(4): 737—55.</p><p>Bonica J.J. Evolution and current status of pain programs. J Pain Symptom Manage 1990; 5(6): 368—74.</p><p>Дубиков А.И. Апоптоз клеток синовиальной оболочки у больных ревматоидным артритом. Тихоокеанск. мед. журн. 2008; 4: 20-3.</p><p>McCarthy G.M. Crystal deposition diseases: out of sight, out of mind. Curr Opin Rheumatol 2005; 17: 312-3.</p><p>Lumbreras B., Pascual E., Frasquet J. et al. Analysis for crystals in synovial fluid: training of the analysts results in high consistency. Ann Rheum Dis 2005; 64: 612-5.</p><p>Pascual E., Jovani V. Synovial fluid analysis. Best Pract Res Clin Rheumatol 2005; 19: 371-86.</p><p>Fuerst M., Bertrand J., Lammers L. et al. Calcification of articular cartilage in human osteoarthritis. Arthr Rheum 2009; 60(9): 2694—703.</p><p>Fuerst M., Niggemeyer O., Lammers L. et al. Articular cartilage mineralization in osteoarthritis of the hip. BMC Musculoskeletal Disorders 2009; 10: 166</p><p>Whelan B.R., O'Shea F., McCarthy G. Pseudoneuropathic CPPD arthropathy: magnesium matters. Rheumatology (Oxford) 2008; 47(4): 551—2.</p><p>So A., Busso N. Crystal-gazing into the pathogenesis of osteoarthritis. Nat Rev Rheumatol 2011; 7: 688-9.</p><p>Mitsuyama H., Healey R.M., Terkeltaub R.A. et al. Calcification of human articular knee cartilage is primarily an effect of aging than osteoarthritis. Osteoarthr Cartilage 2007; 15(5): 559—65.</p><p>Neogi T., Nevitt M., Niu J. et al. Lack of association between chondrocalcinosis and increased risk of cartilage loss in knees with osteoarthritis: results of two prospective longitudinal magnetic resonance imaging studies. Arthr Rheum 2006; 54(6): 1822—8.</p><p>Morgan M.P., Whelan L.C., Sallis J.D. et al. Basic calcium phosphate crystal-induced prostaglandin E2 production in human fibroblasts: role of cyclooxygenase 1, cyclooxygenase 2 and interleukin-1 beta. Arthr Rheum 2004; 50(5): 1642—9.</p><p>McCarthy G.M., Mitchel P.G., Struve J.A., Cheung H.S. Basic calcium phosphate crystals cause coordinate induction and secretion of collagenase and stromelysin. J Cell Physiol 1992; 153: 140-6.</p><p>Невзорова В.А., Тилик Т.В., Гилифанов Е.А. и др. Роль матриксных металлопротеиназ в формировании морфофункционального дисбаланса воздухоносных путей при хронической обструктивной болезни легких. Тихоокеанск. мед. журн. 2011; 2(49): 9—13.</p><p>Ea H.K., Uzan B., Rey C. et al. Octacalcium phosphate crystals directly stimulate expression of inducible nitric oxide synthase through p38 and JNK mitogen-activated protein kinases in articular chondrocytes. Arthr Res Ther 2005; 7(5): 915—26.</p></div><br /><div><p>Насонов Е.Л. Ревматология: Национальное руководство. М.: ГЭОТАР-Медиа, 2011; 99—110.</p><p>Arden N., Nevitt M.C. Osteoarthritis: epidemiology. Best Pract Res Clin Rheumatol 2006; 20: 3-25.</p><p>Ryan L.M., McCarthy D.J. Calcium pyrophosphate crystal deposition disease, pseudogout and articular chondrocalcinosis. In: Arthritis and allied conditions. Ed. by W.J. Koopman. Baltimore: Wiliams &amp; Wilkins, 1997: 2103—5.</p><p>Derfus B.A., Kurian J.B., Butler J.J. et al. The high prevalence of pathologic calcium crystals in pre-operative knees. J Rheumatol 2002; 29(3): 570—4.</p><p>Halverson P.B., McCarty D.J. Patterns of radiographic abnormalities associated with basic calcium phosphate and calcium pyrophosphate dihydrate crystal deposition in the knee. Ann Rheum Dis 1986; 45(7): 603—5.</p><p>Sokoloff L., Varma A.A. Chondrocalcinosis in surgically resected joints. Arthr Rheum 1988; 31(6): 750—6.</p><p>Abreu M., Johnson K., Chung C.B. et al. Calcification in calcium pyrophosphate dihydrate (CPPD) cristalline deposits in the knee: anatomic, radiographic, MR imaging, and histologic study in cadavers. Skeletal Radiol 2004; 33(7): 392—8.</p><p>Mitrovic D.R., Stankovic A., Iriarte-Borda O. et al. The prevalence of chondrocalcinosis in the human knee joint. An autopsy survey. J Rheumatol 1988; 15(4): 633—41.</p><p>Ishikawa K., Masuda I., Ohira T., Yokoyama M. A histological study of calcium pyrophosphate dihydrate crystal-deposition disease. J Bone Joint Surg Am 1989; 71(6): 875—86.</p><p>Ea H.K., Nguyen C., Bazin D. et al. Articular cartilage calcification in osteoarthritis: insights into crystal-induced stress. Arthr Rheum 2011; 63(1): 10—8.</p><p>Rajpura A., Wright A.C., Board T.N. Medical management of osteonecrosis of the hip: a review. Hip Int 2011; 21(4): 385—92.</p><p>Watt I., Dieppe P.A. Medial femoral condyle necrosis and chondrocalcinosis — a causal relationship? Br J Radiol 1983; 56(661): 7—11.</p><p>Насонов Е.Л. Ревматология: Клинические рекомендации. М.: ГЭОТАР-Медиа, 2011; 99—110.</p><p>Altman R., Alarcon G., Appelrouth D. et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthr Rheum 1991; 34: 505-14.</p><p>Kellgren J.H., Lawrence J.S. Radiological assessment of osteoarthrosis. Ann Rheum Dis 1957; 16(4): 494—502.</p><p>Harris W.H. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969; 51(4): 737—55.</p><p>Bonica J.J. Evolution and current status of pain programs. J Pain Symptom Manage 1990; 5(6): 368—74.</p><p>Дубиков А.И. Апоптоз клеток синовиальной оболочки у больных ревматоидным артритом. Тихоокеанск. мед. журн. 2008; 4: 20-3.</p><p>McCarthy G.M. Crystal deposition diseases: out of sight, out of mind. Curr Opin Rheumatol 2005; 17: 312-3.</p><p>Lumbreras B., Pascual E., Frasquet J. et al. Analysis for crystals in synovial fluid: training of the analysts results in high consistency. Ann Rheum Dis 2005; 64: 612-5.</p><p>Pascual E., Jovani V. Synovial fluid analysis. Best Pract Res Clin Rheumatol 2005; 19: 371-86.</p><p>Fuerst M., Bertrand J., Lammers L. et al. Calcification of articular cartilage in human osteoarthritis. Arthr Rheum 2009; 60(9): 2694—703.</p><p>Fuerst M., Niggemeyer O., Lammers L. et al. Articular cartilage mineralization in osteoarthritis of the hip. BMC Musculoskeletal Disorders 2009; 10: 166</p><p>Whelan B.R., O'Shea F., McCarthy G. Pseudoneuropathic CPPD arthropathy: magnesium matters. Rheumatology (Oxford) 2008; 47(4): 551—2.</p><p>So A., Busso N. Crystal-gazing into the pathogenesis of osteoarthritis. Nat Rev Rheumatol 2011; 7: 688-9.</p><p>Mitsuyama H., Healey R.M., Terkeltaub R.A. et al. Calcification of human articular knee cartilage is primarily an effect of aging than osteoarthritis. Osteoarthr Cartilage 2007; 15(5): 559—65.</p><p>Neogi T., Nevitt M., Niu J. et al. Lack of association between chondrocalcinosis and increased risk of cartilage loss in knees with osteoarthritis: results of two prospective longitudinal magnetic resonance imaging studies. Arthr Rheum 2006; 54(6): 1822—8.</p><p>Morgan M.P., Whelan L.C., Sallis J.D. et al. Basic calcium phosphate crystal-induced prostaglandin E2 production in human fibroblasts: role of cyclooxygenase 1, cyclooxygenase 2 and interleukin-1 beta. Arthr Rheum 2004; 50(5): 1642—9.</p><p>McCarthy G.M., Mitchel P.G., Struve J.A., Cheung H.S. Basic calcium phosphate crystals cause coordinate induction and secretion of collagenase and stromelysin. J Cell Physiol 1992; 153: 140-6.</p><p>Невзорова В.А., Тилик Т.В., Гилифанов Е.А. и др. Роль матриксных металлопротеиназ в формировании морфофункционального дисбаланса воздухоносных путей при хронической обструктивной болезни легких. Тихоокеанск. мед. журн. 2011; 2(49): 9—13.</p><p>Ea H.K., Uzan B., Rey C. et al. Octacalcium phosphate crystals directly stimulate expression of inducible nitric oxide synthase through p38 and JNK mitogen-activated protein kinases in articular chondrocytes. Arthr Res Ther 2005; 7(5): 915—26.</p></div><br />

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