rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2016-641-653rsp-2317Research ArticleМЕЖДУНАРОДНЫЕ И РОССИЙСКИЕ РЕКОМЕНДАЦИИ ПО ЛЕЧЕНИЮ РЕВМАТИЧЕСКИХ ЗАБОЛЕВАНИЙINTERNATIONAL AND RUSSIAN GUIDELINES FOR THE TREATMENT OF RHEUMATIC DISEASESАлгоритм лечения остеоартрита коленного сустава Европейского общества по клиническим и экономическим аспектам остеопороза и остеоартрита (ESCEO) применим в российской клинической практике: совместное заключение ведущих российских специалистов и экспертов ESCEO по остеоартритуTHE EUROPEAN SOCIETY FOR CLINICAL AND ECONOMIC ASPECTS OF OSTEOPOROSIS AND OSTEOARTHRITIS (ESCEO) ALGORITHM FOR THE MANAGEMENT OF KNEE OSTEOARTHRITIS IS APPLICABLE TO RUSSIAN CLINICAL PRACTICE: A CONSENSUS STATEMENT OF LEADING RUSSIAN AND ESCEO OSTEOARTHRITIS EXPERTSДенисовЛ. Н.DenisovL. N.

115522 Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

sokrat@irramn.ruЦветковаЕ. С.TsvetkovaE. S.

115522 Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

ГолубевГ. Ш.GolubevG. Sh.

344022 Ростов-на-Дону, Нахичеванский переулок, 29

29, Nakhichevansky Lane, Rostov-on-Don 344022

БугроваО. В.BugrovaO. V.

460000 Оренбург, ул. Советская, 6

6, Sovetskaya St., Orenburg 460000

ДыдыкинаИ. С.DydykinaI. S.

115522 Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

ДубиковА. И.DubikovA. I.

690002 Владивосток, проспект Острякова, 2

2, Ostryakov Prospect, Vladivostok 690002

МеньшиковаЛ. В.MenshikovaL. V.

664049 Иркутск, м/р Юбилейный,100

100, Yubileinyi Microdistrict, Irkutsk 664049

ПешехоноваЛ. К.PeshekhonovaL. K.

394024 Воронеж, переулок Здоровья, 2

2, Zdorovye Lane, Voronezh 394024

РебровА. П.RebrovA. P.

410012 Саратов, ул. Большая Казачья, 112

112, Bolshaya Kazachya St., Saratov 410012

ТоргашинА. Н.TorgashinA. N.

127299 Москва, ул. Приорова, 10

10, Priorov St., Moscow 127299

ТрофимовЕ. А.TrofimovE. A.

191015 Санкт-Петербург, ул. Кирочная, 41

41, Kirochnaya St., Saint Petersburg 191015

ЯкуповаС. П.YakupovaS. P.

420012 Казань, ул. Бутлерова, 49

49, Butlerov St., Kazan 420012

ЗоноваЕ. В.ZonovaE. V.

630003 Новосибирск, Владимировский спуск, 2а

2a, Vladimirovsky Slope, Novosibirsk 630003

БрюйерО.BrewerO.

Universite de Liege Place du 20-Aout, 7 4000 Liege Belgique

Department of Public Health 

Universite de Liege Place du 20-Aout, 7 4000 Liege, Belgique

КуперС.CooperC.

University of Southampton, University Road, Southampton, SO17 1BJ, United Kingdom;

Medical Sciences Divisional Office University of Oxford Level 3, John Radcliffe Hospital Oxford OX3 9DU, United Kingdom

University of Southampton, University Road, Southampton, SO17 1BJ, United Kingdom

РеджинстерЖ.ReginsterJ.

Universite de Liege Place du 20-Aout, 7 4000 Liege Belgique

Medical Sciences Divisional Office University of Oxford Level 3, John Radcliffe Hospital Oxford OX3 9DU, United

КнязеваЛ. А.KnyazevaL. A.

305041 Курск, ул. К. Маркса, 3

3, K. Marx St., Kursk 305041

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian FederationФГБОУ ВО «Ростовский государственный медицинский университет» Минздрава РоссииРоссияRostov State Medical University, Ministry of Health of RussiaRussian FederationФГБОУ ВО «Оренбургский государственный медицинский университет» Минздрава РоссииРоссияOrenburg State Medical University, Ministry of Health of RussiaRussian FederationФГБОУ ВО «Тихоокеанский государственный медицинский университет» Минздрава РоссииРоссияPacific State Medical University, Ministry of Health of RussiaRussian FederationГБОУ ДПО «Иркутская государственная медицинская академия последипломного образования»РоссияIrkutsk State Medical Academy of Postgraduate EducationRussian FederationНУЗ «Дорожная клиническая больница на станции Воронеж-1» ОАО «РЖД»РоссияRailway Clinical Hospital at the Voronezh-1 Station, OAO «RZhD»Russian FederationФГБОУ ВО«Саратовский государственный медицинский университет им. В.И. Разумовского» Минздрава РоссииРоссияV.I. Razumovsky Saratov State Medical University, Ministry of Health of RussiaRussian FederationФГБУ «Центральный научно-исследовательский институт травматологии и ортопедии им. Н.Н. Приорова» Минздрава РоссииРоссияN.N. Priorov Central Research Institute of Traumatology and Orthopedics, Ministry of Health of RussiaRussian FederationФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава РоссииРоссияI.I. Mechnikov North-Western State Medical University, Ministry of Health of RussiaRussian FederationФГБОУ ВО «Казанский государственный медицинский университет» Минздрава РоссииРоссияKazan State Medical University, Ministry of Health of RussiaRussian FederationНУЗ «Дорожная клиническая больница на станции Новосибирск- Главный» ОАО «РЖД»РоссияRailway Clinical Hospital at the Novosibirsk-Main Station, OAO «RZhD»Russian FederationУниверситет Льежа, Клинический университетский центр в Сарт Тильмане, кафедра общественного здравоохранения, эпидемиологии и экономики здравоохраненияРоссияEpidemiology, and Health Economics, Centre Hospitalier Universitaire in Sart-Tilman, Universite de LiegeRussian FederationУниверситет Саутгемптона, совет по медицинским исследованиям, отделение эпидемиологии отдаленных последствий, Саутгемптон, Великобритания; Оксфордский университет, Национальный институт исследований в области здравоохранения, отдел биомедицинских исследований по заболеваниям опорно-двигательного аппаратаРоссияMRC Lifecourse Epidemiology Unit, University of SouthamptonRussian FederationУниверситет Льежа, Клинический университетский центр в Сарт Тильмане, кафедра общественного здравоохранения, эпидемиологии и экономики здравоохраненияРоссияNIHR Musculoskeletal Biomedical Research Unit, University of OxfordRussian FederationФГБОУ ВО «Курский государственный медицинский университет» Минздрава РоссииРоссияKursk State Medical University, Ministry of Health of RussiaRussian Federation201617012017546641653Copyright © Денисов Л.Н., Цветкова Е.С., Голубев Г.Ш., Бугрова О.В., Дыдыкина И.С., Дубиков А.И., Меньшикова Л.В., Пешехонова Л.К., Ребров А.П., Торгашин А.Н., Трофимов Е.А., Якупова С.П., Зонова Е.В., Брюйер О., Купер С., Реджинстер Ж., Князева Л.А., 20172017Денисов Л.Н., Цветкова Е.С., Голубев Г.Ш., Бугрова О.В., Дыдыкина И.С., Дубиков А.И., Меньшикова Л.В., Пешехонова Л.К., Ребров А.П., Торгашин А.Н., Трофимов Е.А., Якупова С.П., Зонова Е.В., Брюйер О., Купер С., Реджинстер Ж., Князева Л.А.Denisov L.N., Tsvetkova E.S., Golubev G.S., Bugrova O.V., Dydykina I.S., Dubikov A.I., Menshikova L.V., Peshekhonova L.K., Rebrov A.P., Torgashin A.N., Trofimov E.A., Yakupova S.P., Zonova E.V., Brewer O., Cooper C., Reginster J., Knyazeva L.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/2317

Разработанный Европейским обществом по клиническим и экономическим аспектам остеопороза и остеоартрита (ESCEO) алгоритм лечения остеоартрита (ОА) коленного сустава (КС), опубликованный в декабре 2014 г., представляет собой практическое руководство для определения приоритетности лечебных мероприятий. В статье представлена оценка алгоритма российскими экспертами по ОА. Алгоритм поддержан ими для использования в российской клинической практике, с целью предоставления рекомендаций по лечению пациентов с ОА КС для обеспечения персональной оценки состояния пациента врачом-клиницистом. Рекомендованные в алгоритме ESCEO лекарственные препараты доступны в России. На первом этапе рекомендована базовая поддерживающая терапия с применением симптоматических препаратов замедленного действия для лечения ОА (SYSADOA), из которых доказательства высокого уровня получены только для лекарственных форм запатентованного кристаллического глюкозамина сульфата (пКГС; Роттафарм/Меда) и рецептурного хондроитина сульфата. Парацетамол может быть добавлен только для экстренного обезболивания по причине его ограниченной эффективности и безопасности. Топические нестероидные противовоспалительные препараты (НПВП) могут обеспечить дополнительное симптоматическое лечение с той же степенью эффективности, как пероральные НПВП, но без системных побочных эффектов. Чтобы быть эффективными, топические НПВП должны иметь высокую биодоступность, и такие молекулы, как этофенамат, обладают высокой абсорбцией и биодоступностью наряду с признаками накопления в синовиальной ткани. Перорально применяемые НПВП сохраняют центральную роль на втором этапе, расширяя возможности терапии у пациентов с сохраняющимися симптомами. Тем не менее пероральные формы НПВП очень неоднородны с точки зрения профиля безопасности в отношении желудочно-кишечного тракта и сердечно-сосудистой системы, и для увеличения соотношения пользы и риска рекомендуется стратификация пациентов с тщательным выбором терапии. Внутрисуставное введение гиалуроновой кислоты в качестве следующего этапа обеспечивает устойчивый клинический эффект продолжительностью до 6 мес после короткого курса еженедельных инъекций. В качестве последнего этапа перед операцией рекомендуется осторожный подбор дозы слабого опиоида с замедленным высвобождением – трамадола, который обеспечивает устойчивое обезболивание с более высокой переносимостью.

The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm for the management of knee osteoarthritis (OA), published in December 2014, provides practical guidance for the prioritization of interventions. This current paper represents an assessment and endorsement of the algorithm by Russian experts in OA for use in Russian clinical practice, with the aim of providing easy-to-follow advice on how to establish a treatment flow in patients with knee OA, in support of the clinicians’ individualized assessment of the patient. Medications recommended by the ESCEO algorithm are available in Russia. In step 1, background maintenance therapy with symptomatic slow-acting drugs for osteoarthritis (SYSADOA) is advised, for which high-quality evidence is provided only for the formulations of patented crystalline glucosamine sulphate (pCGS) (Rottapharm/Meda) and prescription chondroitin sulfate. Paracetamol may be added for rescue analgesia only, due to limited efficacy and increasing safety signals. Topical non-steroidal anti-inflammatory drugs (NSAIDs) may provide additional symptomatic treatment with the same degree of efficacy as oral NSAIDs but without the systemic safety concerns. To be effective, topical NSAIDs must have high bioavailability, and among NSAIDs molecules like etofenamate have high absorption and bioavailability alongside evidence for accumulation in synovial tissues. Oral NSAIDs maintain a central role in step 2 advanced management of persistent symptoms. However, oral NSAIDs are highly heterogeneous in terms of gastrointestinal and cardiovascular safety profile, and patient stratification with careful treatment selection is advocated to maximize the risk: benefit ratio. Intra-articular hyaluronic acid as a next step provides sustained clinical benefit with effects lasting up to 6 months after a short-course of weekly injections. As a last step before surgery, the slow titration of sustained-release tramadol, a weak opioid, affords sustained analgesia with improved tolerability.

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