rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2018-239-248rsp-2531Research ArticleОБЗОРREVIEWИнъекционные препараты гиалуроновой кислоты для лечения гонартроза с позиций доказательной медициныINJECTABLE HYALURONIC ACID DRUGS FOR THE TREATMENT OF KNEE OSTEOARTHRITIS IN THE CONTEXT OF EVIDENCE-BASED MEDICINEПетуховА. И.PetukhovA. I.

Алексей Иванович Петухов.

Санкт-Петербург

Aleksey Petukhov.

Saint Petersburg

drpetukhov@yandex.ruКорниловН. Н.KornilovN. N.

Санкт-Петербург

Saint Petersburg

КулябаТ. А.KulyabaT. A.

Санкт-Петербург

Saint Petersburg

ФГБУ «Российский ордена Трудового Красного Знамени научноисследовательский институт травматологии и ортопедии имени Р.Р. Вредена» Минздрава РоссииРоссияR.R.Vreden Russian Order of the Red Banner of Labor Research Institute of Traumatology and Orthopedics, Ministry of Health of RussiaRussian Federation201808052018562239248Copyright © Петухов А.И., Корнилов Н.Н., Куляба Т.А., 20182018Петухов А.И., Корнилов Н.Н., Куляба Т.А.Petukhov A.I., Kornilov N.N., Kulyaba T.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/2531

Для оценки эффективности и безопасности внутрисуставного применения гиалуроновой кислоты (ГНК) при остеоартрите (ОА) проанализированы включенные в зарубежные базы данных (Medline/PubMed) научные публикации, посвященные актуальным лабораторным, экспериментальным и клиническим исследованиям, проведенным за последние 20 лет. Результаты немногочисленных лабораторных исследований (in vitro) отдельных препаратов ГНК подтверждают их положительное влияние на суставной хрящ. Анализ литературы, посвященной их применению in vivo, показал, что целый ряд разрешенных к применению в России препаратов ГНК для внутрисуставного введения не изучались в клинических исследованиях, что вызывает сомнения в их эффективности. В то же время опубликованные работы свидетельствуют о достижении значимого клинического эффекта терапии ГНК, преимущественно на ранней стадии ОА, и неудовлетворительных результатах ее применения при терминальном гонартрозе. Данные, касающиеся сопоставления клинической эффективности различных препаратов, весьма противоречивы. Таким образом, необходимы дополнительные постмаркетинговые сравнительные исследования разрешенных к применению в Российской Федерации препаратов ГНК со стратификацией пациентов в зависимости от особенностей клинического фенотипа заболевания, имеющихся факторов риска прогрессирования ОА, а также степени морфологических изменений тканей сустава, верифицированной при магнитно-резонансной томографии и/или артроскопии.

To evaluate the efficacy and safety of intraarticular hyaluronic acid (HA) in osteoarthritis (OA), the authors have analyzed the scientific publications included in foreign databases (Medline/PubMed) on the relevant laboratory, experimental, and clinical studies conducted over the past 20 years. A few in vitro laboratory studies of individual HA drugs confirm their positive effect on articular cartilage. Analysis of the literature on their in vivo use has shown that a variety of intraarticular HA drugs permitted for use in Russia have not been studied in clinical trials, which raises doubts about their efficacy. At the same time, the published works suggest that a significant clinical effect is achieved with HA therapy mainly in early OA and that this therapy for end-stage knee OA yields poor results. The data regarding the clinical efficacy of different HA drugs are very contradictory. Thus, there is a need for additional comparative postmarketing research of HA drugs permitted for use in the Russian Federation, by stratifying patients according to the characteristics of the clinical phenotype of the disease, available risk factors for OA progression, and the magnitude of morphological changes in joint tissues, as verified by magnetic resonance imaging and/or arthroscopy.

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