rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2022-420-426rsp-3194Research ArticleПРОБЛЕМЫ РЕВМАТОЛОГИИ В ПЕРИОД ПАНДЕМИИ КОРОНОВИРУСНОЙ БОЛЕЗНИ 2019PROBLEMS OF RHEUMATOLOGY DURING THE 2019 CORONAVIRUS PANDEMICАваскулярный некроз как проявление постковидного синдрома. Клинические наблюденияAvascular necrosis as a part of post-COVID syndrome. Case reportshttps://orcid.org/0000-0003-2641-9785БекетоваТ. В.BeketovaT. V.

121356, Москва, ул. Маршала Тимошенко, 15;

115522, Москва, Каширское шоссе, 34а;

107023, Москва, ул. Большая Семёновская, 38

https://orcid.org/0000-0003-4546-9817ЛевинаН. О.LevinaN. O.

121356, Москва, ул. Маршала Тимошенко, 15

121359, Moscow, Marshala Timoshenko str., 19, building 1A

https://orcid.org/0000-0001-6418-7060ЛадыгинаД. О.LadyginaD. O.

121356, Москва, ул. Маршала Тимошенко, 15

121359, Moscow, Marshala Timoshenko str., 19, building 1A

https://orcid.org/0000-0001-8020-2494БабакВ. В.BabakV. V.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0001-5562-0969БекетоваМ. Ф.BeketovaM. F.

119991, Москва, Ленинские горы, 12

119991, Moscow, Leninskie Gory, 12

tvbek@rambler.ruhttps://orcid.org/0000-0001-6175-1076КрасноваТ. Н.KrasnovaT. N.

119991, Москва, Ленинские горы, 12

119991, Moscow, Leninskie Gory, 12

ФГБУ «Центральная клиническая больница с поликлиникой» Управления делами Президента Российской Федерации; ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»; ФГАОУ ВО «Московский политехнический университет»РоссияCentral State Medical Academy of the Administrative Directorate of the President of the Russian Federation; V.A. Nasonova Research Institute of Rheumatology; Moscow Polytechnic UniversityRussian FederationФГБУ «Центральная клиническая больница с поликлиникой» Управления делами Президента Российской ФедерацииРоссияCentral State Medical Academy of the Administrative Directorate of the President of the Russian FederationRussian FederationФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian FederationФГБОУ ВО «Московский государственный университет имени М.В. Ломоносова»РоссияLomonosov Moscow State UniversityRussian Federation202206092022604420426Copyright © Бекетова Т.В., Левина Н.О., Ладыгина Д.О., Бабак В.В., Бекетова М.Ф., Краснова Т.Н., 20222022Бекетова Т.В., Левина Н.О., Ладыгина Д.О., Бабак В.В., Бекетова М.Ф., Краснова Т.Н.Beketova T.V., Levina N.O., Ladygina D.O., Babak V.V., Beketova M.F., Krasnova T.N.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/3194

Коронавирусная болезнь 2019 (COVID-19, coronavirus disease 2019) может проявляться широким спектром внелегочных симптомов и иметь отдаленные последствия в рамках так называемого постковидного синдрома (ПКС). Проявления ПКС демонстрируют широкий клинический спектр и включают, наряду с кардиологическими, пульмонологическими, неврологическими, желудочно-кишечными, дерматологическими, психическими симптомами, сосудистые тромбозы и аваскулярный некроз (АВН) костей.

Представлены собственные наблюдения развития АВН костей у 3 пациенток, перенесших COVID-19, с двусторонним поражением легких, у которых через 4–9 месяцев отмечено появление первых признаков АВН, характеризовавшихся прогрессирующим многоочаговым поражением костей, подтвержденным при магнитно-резонансной томографии, что сопровождалось повышением уровня С-реактивного белка.

Обсуждаются патогенетические механизмы развития АВН в рамках ПКС. Рассматривается значение консервативных и хирургических методов в лечении заболевания. Поскольку после COVID-19 возможно развитие АВН костей различной локализации, в том числе с длительным латентным периодом, требуется продолжительный мониторинг пациентов после коронавирусной инфекции. Необходимо дальнейшее изучение проблемы ПКС, включая АВН. 

Coronavirus disease 2019 (COVID-19) can manifest with a wide range of extrapulmonary symptoms and have longterm consequences (so-called post-covid syndrome (PCS) or “long COVID-19”). Manifestations of PCS show a wide clinical spectrum and include cardiac, pulmonary, neurological, gastrointestinal, dermatological, mental symptoms, vascular thrombosis and avascular necrosis (AVN) of the bones.

We present our own observations of the development of bone’s AVN in 3 patients who underwent COVID-19 with bilateral lung disease, in whom after 4–6 months the first signs of AVN were noted and characterized by a progressive multifocal lesion, which was accompanied by an increase of C-reactive protein concentration.

The pathogenetic mechanisms of AVN development in the framework of PCS are discussed. The importance of conservative and surgical methods in the treatment of the disease are considered. Since the development of AVN of various localizations with a long latent period is possible after COVID-19, long-term monitoring of patients is required. Further study of the problem of PCS in general and AVN in particular is required. 

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