Алгоритм 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 остеоартриту

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.

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