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Научно-практическая ревматология

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Остеоартрит: современная клиническая концепция и некоторые перспективные терапевтические подходы

https://doi.org/10.14412/1995-4484-2018-70-81

Аннотация

В последние годы наметилась тенденция к изменению клинической концепции остеоартрита (ОА). Очень долго это заболевание рассматривалось как «возрастная патология» и исход длительно текущего патологического процесса. Однако сейчас многие эксперты склоняются к необходимости выделения ранней, дорентгенологической стадии ОА, когда адекватная терапия может не только остановить прогрессирование, но и добиться обратного развития структурных изменений сустава. В настоящем обзоре рассмотрены ряд патогенетических и клинических аспектов ранней стадии ОА, важных для своевременной диагностики и выбора патогенетической терапии. Рассмотрены некоторые терапевтические подходы, как «классические», так и активно обсуждаемые в последнее время методики применения обогащенной тромбоцитами плазмы и аутологичной трансплантации хондроцитов.

Об авторах

А. Е. Каратеев
ФГБНУ «Научноисследовательский институт ревматологии им. В.А.Насоновой».
Россия

заведующий лабораторией патофизиологии боли и клинического полиморфизма скелетно-мышечных заболеваний, доктор медицинских наук.

Москва.



А. М. Лила
ФГБНУ «Научноисследовательский институт ревматологии им. В.А.Насоновой».
Россия

профессор, врио директора, доктор медицинских наук.

Москва.



Список литературы

1. Алексеева ЛИ, Шарапова ЕП, Кашеварова НГ, Пьяных СЕ. Новые возможности в терапии остеоартроза. Справочник поликлинического врача. 2015;(6-8):4-7 [Alekseeva LI, Sharapova EP, Kashevarova NG, P'yanykh SE. New possibilities in the therapy of osteoarthritis. Spravochnik Poliklinicheskogo Vracha. 2015;(6-8):4-7 (In Russ.)].

2. Martel-Pelletier J, Barr AJ, Cicuttini FM, et al. Osteoarthritis. Nat Rev Dis Primers. 2016 Oct 13;2:16072. doi: 10.1038/nrdp.2016.72

3. Cross M, Smith E, Hoy D, et al. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014;73(7):1323-30. doi: 10.1136/annrheumdis-2013-204763

4. Балабанова РМ, Эрдес ШФ. Распространенность ревматических заболеваний в России в 2012–2013 гг. Научнопрактическая ревматология. 2015;53(2):120-4 [Balabanova RM, Erdes ShF. The incidence and prevalence of rheumatic diseases in Russia in 2012–2013. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2015;53(2):120-4 (In Russ.)]. doi: 10.14412/1995-4484-2015-120-124

5. Фоломеева OM, Галушко ЕА, Эрдес ШФ. Распространенность ревматических заболеваний в популяциях взрослого населения России и США. Научнопрактическая ревматология. 2008;46(4):4-13 [Folomeeva OM, Galushko EA, Erdes ShF. Prevalence of rheumatic diseases in adult populations of Russian Federation and USA. NauchnoPrakticheskaya Revmatologiya = Rheumatology Science and Practice. 2008;46(4):4-13 (In Russ.)]. doi: 10.14412/1995-4484-2008-529

6. Arthritis-Related Statistics: Prevalence of Arthritis in the United States. Centers for Disease Control and Prevention, US Department of Health and Human Services. 9 November 2016. Available from: https://www.cdc.gov/arthritis/data_statistics/arthritis-related-stats.htm

7. Pfuntner A, Wier LM, Stocks C. Most Frequent Conditions in U.S. Hospitals, 2011: Statistical Brief #162. Source Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006-2013 Sep.

8. Ellen M. Knowledge Translation Framework for Ageing and Health. Prepared for the Department of Ageing and Life-Course. World Health Organization; 2012. Available from: http://www.who.int/ageing/publications/knowledge_translation.pdf

9. World Health Organization (WHO). World report on ageing and health WHO Press. Geneva: World Health Organization; 2015. Available from: http://www.who.int/ageing/events/world-report2015-launch/en/

10. Brandt KD. Diagnosis and nonsurgical management of osteoarthritis. Professional communications, Inc.; 2000. P. 304.

11. Loeser RF, Goldring SR, Scanzello CR, Goldring MB. Osteoarthritis – a disease of the joint as an organ. Arthritis Rheum. 2012 Jun;64(6):1697-707. doi: 10.1002/art.34453. Epub 2012 Mar 5.

12. Favero M, Ramonda R, Goldring MB, et al. Early knee osteoarthritis. RMD Open. 2015 Aug 15;1(Suppl 1):e000062. doi: 10.1136/rmdopen-2015-000062. eCollection 2015.

13. Scanzello CR. Role of low-grade inflammation in osteoarthritis. Curr Opin Rheumatol. 2017 Jan;29(1):79-85. doi: 10.1097/BOR.0000000000000353

14. Robinson WH, Lepus CM, Wang Q, et al. Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis. Nat Rev Rheumatol. 2016 Oct;12(10):580-92. doi: 10.1038/nrrheum.2016.136. Epub 2016 Aug 19.

15. Mathiessen A, Conaghan PG. Synovitis in osteoarthritis: current understanding with therapeutic implications. Arthritis Res Ther. 2017 Feb 2;19(1):18. doi: 10.1186/s13075-017-1229-9

16. Carballo CB, Nakagawa Y, Sekiya I, Rodeo SA. Basic science of articular cartilage. Clin Sports Med. 2017 Jul;36(3):413-25. doi: 10.1016/j.csm.2017.02.001. Epub 2017 Apr 26.

17. Goldring MB. Chondrogenesis, chondrocyte differentiation, and articular cartilage metabolism in health and osteoarthritis. Ther Adv Musculoskelet Dis. 2012 Aug;4(4):269-85. doi: 10.1177/1759720X12448454

18. Komori T. Cell death in chondrocytes, osteoblasts, and osteocytes. Int J Mol Sci. 2016 Dec 6;17(12). pii: E2045. doi: 10.3390/ijms17122045

19. Rosenberg JH, Rai V, Dilisio MF, Agrawal DK. Damage-associated molecular patterns in the pathogenesis of osteoarthritis: potentially novel therapeutic targets. Mol Cell Biochem. 2017 May 4. doi: 10.1007/s11010-017-3047-4 [Epub ahead of print].

20. Kotas ME, Medzhitov R. Homeostasis, inflammation, and disease susceptibility. Cell. 2015 Feb 26;160(5):816-27. doi: 10.1016/j.cell.2015.02.010

21. Sugimoto MA, Sousa LP, Pinho V, et al. Resolution of inflammation: What controls its onset? Front Immunol. 2016 Apr 26;7:160. doi: 10.3389/fimmu.2016.00160. eCollection 2016.

22. Freire MO, van Dyke TE. Natural resolution of inflammation. Periodontol 2000. 2013 Oct;63(1):149-64. doi: 10.1111/prd.12034

23. Lee AS, Ellman MB, Yan D, et al. A current review of molecular mechanisms regarding osteoarthritis and pain. Gene. 2013 Sep 25;527(2):440-7. doi: 10.1016/j.gene.2013.05.069. Epub 2013 Jul 2.

24. Carbone A, Rodeo S. Review of current understanding of posttraumatic osteoarthritis resulting from sports injuries. J Orthop Res. 2017 Mar;35(3):397-405. doi: 10.1002/jor.23341. Epub 2016 Jul 22.

25. Courties A, Gualillo O, Berenbaum F, Sellam J. Metabolic stressinduced joint inflammation and osteoarthritis. Osteoarthritis Cartilage. 2015 Nov;23(11):1955-65. doi: 10.1016/j.joca.2015.05.016. Epub 2015 May 30.

26. Belluzzi E, El Hadi H, Granzotto M, et al. Systemic and local adipose tissue in knee osteoarthritis. J Cell Physiol. 2017 Aug;232(8):1971-8. doi: 10.1002/jcp.25716. Epub 2017 Mar 3.

27. Stefano GB, Kream RM. Hypoxia defined as a common culprit/initiation factor in mitochondrial-mediated proinflammatory processes. Med Sci Monit. 2015 May 22;21:1478-84. doi: 10.12659/MSM.894437

28. Boutens L, Stienstra R. Adipose tissue macrophages: going off track during obesity. Diabetologia. 2016 May;59(5):879-94. doi: 10.1007/s00125-016-3904-9. Epub 2016 Mar 3.

29. Sun AR, Friis T, Sekar S, et al. Is synovial macrophage activation the inflammatory link between obesity and osteoarthritis? Curr Rheumatol Rep. 2016 Sep;18(9):57. doi: 10.1007/s11926-0160605-9

30. Courties A, Sellam J. Osteoarthritis and type 2 diabetes mellitus: What are the links? Diabetes Res Clin Pract. 2016 Dec;122:198-206. doi: 10.1016/j.diabres.2016.10.021. Epub 2016 Nov 5.

31. Laiguillon MC, Courties A, Houard X, et al. Characterization of diabetic osteoarthritic cartilage and role of high glucose environment on chondrocyte activation: toward pathophysiological delineation of diabetes mellitus-related osteoarthritis. Osteoarthritis Cartilage. 2015 Sep;23(9):1513-22. doi: 10.1016/j.joca.2015.04.026. Epub 2015 May 15.

32. Antony B, Jones G, Jin X, Ding C. Do early life factors affect the development of knee osteoarthritis in later life: a narrative review. Arthritis Res Ther. 2016 Sep 13;18(1):202. doi: 10.1186/s13075016-1104-0

33. Pritzker KP, Gay S, Jimenez SA, et al. Osteoarthritis cartilage histopathology: grading and staging. Osteoarthritis Cartilage. 2006 Jan;14(1):13-29. doi: 10.1016/j.joca.2005.07.014. Epub 2005 Oct 19.

34. Madry H, Luyten FP, Facchini A. Biological aspects of early osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2012 Mar;20(3):407-22. doi: 10.1007/s00167-011-1705-8. Epub 2011 Oct 19.

35. Driban JB, Price LL, Eaton CB, et al. Individuals with incident accelerated knee osteoarthritis have greater pain than those with common knee osteoarthritis progression: data from the Osteoarthritis Initiative. Clin Rheumatol. 2016 Jun;35(6):1565-71. doi: 10.1007/s10067-015-3128-2. Epub 2015 Nov 27.

36. Luyten FP, Bierma-Zeinstra S, Dell'Accio F, et al. Toward classification criteria for early osteoarthritis of the knee. Semin Arthritis Rheum. 2017 Aug 9. pii: S0049-0172(17)30098-7. doi: 10.1016/j.semarthrit.2017.08.006 [Epub ahead of print].

37. Luyten FP, Denti M, Filardo G, et al. Definition and classification of early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc. 2012 Mar;20(3):401-6. doi: 10.1007/s00167-011-1743-2. Epub 2011 Nov 8.

38. Зайцева ЕМ, Алексеева ЛИ, Смирнов АВ, Насонов ЕЛ. Магнитно-резонансная томография при остеоартрозе. Научно-практическая ревматология. 2006;44(5):59-75 [Zaitseva EM, Alekseeva LI, Smirnov AV, Nasonov EL. Magnetic resonance imaging for osteoarthritis. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2006;44(5):59-75 (In Russ.)].

39. Rowbotham EL, Grainger AJ. Magnetic resonance imaging of arthritis of the knee. Semin Musculoskelet Radiol. 2017 Apr;21(2):113-21. doi: 10.1055/s-0037-1599213. Epub 2017 Mar 29.

40. Boesen M, Ellegaard K, Henriksen M, et al. Osteoarthritis year in review 2016: imaging. Osteoarthritis Cartilage. 2017 Feb;25(2):216226. doi: 10.1016/j.joca.2016.12.009. Epub 2016 Dec 10.

41. Guermazi A, Niu J, Hayashi D, et al. Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study). BMJ. 2012 Aug 29;345:e5339. doi: 10.1136/bmj.e5339

42. Englund M, Guermazi A, Gale D, et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008 Sep 11;359(11):1108-15. doi: 10.1056/NEJMoa0800777

43. Hayashi D, Felson DT, Niu J, et al. Pre-radiographic osteoarthritic changes are highly prevalent in the medial patella and medial posterior femur in older persons: Framingham OA study. Osteoarthritis Cartilage. 2014 Jan;22(1):76-83. doi: 10.1016/j.joca.2013.10.007. Epub 2013 Nov 1.

44. Sharma L, Chmiel JS, Almagor O, et al. Significance of preradiographic magnetic resonance imaging lesions in persons at increased risk of knee osteoarthritis. Arthritis Rheum. 2014 Jul;66(7):1811-9. doi: 10.1002/art.38611

45. Petersen KK, Siebuhr AS, Graven-Nielsen T, et al. Sensitization and serological biomarkers in knee osteoarthritis patients with different degrees of synovitis. Clin J Pain. 2016 Oct;32(10):841-8. doi: 10.1097/AJP.0000000000000334

46. Filardo G, Kon E, Longo UG, et al. Non-surgical treatments for the management of early osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2016 Jun;24(6):1775-85. doi: 10.1007/s00167016-4089-y. Epub 2016 Apr 4.

47. Pelletier J-P, Martel-Pelletier J, Rannou F, Cooper C. Efficacy and safety of oral NSAIDs and analgesics in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Semin Artritits Rheum. 2016 Feb;45(4 Suppl):s22-77. doi: 10.1016/j.semartritis.2015.11.009. Epub 2015 Dec 2.

48. Strand V, Simon L, Dougados M, et al. Treatment of osteoarthritis with continuous versus intermittent celecoxib. J Rheumatol. 2011;38(12):2625-34. doi: 10.3899/jrheum.110636

49. Bruyere O, Cooper C, Pelletier JP, et al. A consensus statement on the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) algorithm for the management of knee osteoarthritis-From evidence-based medicine to the real-life setting. Semin Arthritis Rheum. 2016 Feb; 45(4 Suppl):S3-11. doi: 10.1016/j.semarthrit.2015.11.010

50. McAlindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cart. 2014 Mar;22(3):363-88. doi: 10.1016/j.joca.2014.01.003. Epub 2014 Jan 24.

51. McAlindon TE, LaValley MP, Harvey WF, et al. Effect of intraarticular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: A randomized clinical trial. JAMA. 2017 May 16;317(19):1967-75. doi: 10.1001/jama.2017.5283

52. Wenham CY, Grainger AJ, Hensor EM, et al. Methotrexate for pain relief in knee osteoarthritis: an open-label study. Rheumatology (Oxford). 2013 May;52(5):888-92. doi: 10.1093/rheumatology/kes386. Epub 2013 Jan 7.

53. Wang J. Efficacy and safety of adalimumab by intra-articular injection for moderate to severe knee osteoarthritis: An open-label randomized controlled trial. J Int Med Res. 2017 Jan 1:300060517723182. doi: 10.1177/0300060517723182 [Epub ahead of print].

54. Chevalier X, Goupille P, Beaulieu AD, et al. Intraarticular injection of anakinra in osteoarthritis of the knee: a multicenter, randomized, double-blind, placebo-controlled study. Arthritis Rheum. 2009 Mar 15;61(3):344-52. doi: 10.1002/art.24096

55. Pavelka K, Bruyere O, Cooper C, et al. Diacerein: benefits, risks and place in the management of osteoarthritis. An opinion-based report from the ESCEO. Drugs Aging. 2016 Feb;33(2):75-85. doi: 10.1007/s40266-016-0347-4

56. Pavlovic V, Ciric M, Jovanovic V, Stojanovic P. Platelet Rich Plasma: a short overview of certain bioactive components. Open Med (Wars). 2016 Aug 12;11(1):242-7. doi: 10.1515/med-20160048. eCollection 2016.

57. Wu PI, Diaz R, Borg-Stein J. Platelet-Rich Plasma. Phys Med Rehabil Clin N Am. 2016 Nov;27(4):825-53. doi: 10.1016/j.pmr.2016.06.002

58. Frizziero A, Vittadini F, Pignataro A, et al. Conservative management of tendinopathies around hip. Musc Lig Tend J. 2016 Dec 21;6(3):281-92. doi: 10.11138/mltj/2016.6.3.281. eCollection 2016 Jul-Sep.

59. Chiew SK, Ramasamy TS, Amini F. Effectiveness and relevant factors of platelet-rich plasma treatment in managing plantar fasciitis: A systematic review. J Res Med Sci. 2016 Jun 14;21:38. eCollection 2016.

60. Everhart JS, Cole D, Sojka JH, et al. Treatment options for patellar tendinopathy: A systematic review. Arthroscopy. 2017 Apr;33(4):861-72. doi: 10.1016/j.arthro.2016.11.007. Epub 2017 Jan 16.

61. Mlynarek RA, Kuhn AW, Bedi A. Platelet-Rich Plasma (PRP) in Orthopedic Sports Medicine. Am J Orthop (Belle Mead NJ). 2016 Jul-Aug;45(5):290-326.

62. Knezevic NN, Mandalia S, Raasch J, et al. Treatment of chronic low back pain – new approaches on the horizon. J Pain Res. 2017 May 10;10:1111-23. doi: 10.2147/JPR.S132769. eCollection 2017.

63. Keene DJ, Alsousou J, Willett K. How effective are platelet rich plasma injections in treating musculoskeletal soft tissue injuries? BMJ. 2016 Feb 17;352:i517. doi: 10.1136/bmj.i517

64. Navani A, Li G, Chrystal J. Platelet rich plasma in musculoskeletal pathology: A necessary rescue or a lost cause? Pain Phys. 2017 Mar;20(3):E345-E356.

65. Moraes V, Lenza M, Tamaoki MJ, et al. Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane Database Syst Rev. 2014 Apr 29;4:CD010071. doi: 10.1002/14651858.CD010071.pub3

66. Kon E, Buda R, Filardo G, et al. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc. 2010 Apr;18(4):472-9. doi: 10.1007/s00167-009-0940-8. Epub 2009 Oct 17.

67. Bennell KL, Hunter DJ, Paterson KL. Platelet-rich plasma for the management of hip and knee osteoarthritis. Curr Rheumatol Rep. 2017 May;19(5):24. doi: 10.1007/s11926-017-0652-x

68. Laudy AB, Bakker EW, Rekers M, Moen MH. Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis. Br J Sports Med. 2015 May;49(10):657-72. doi: 10.1136/bjsports-2014-094036. Epub 2014 Nov 21.

69. Научно-практическая ревматология. 2018;56(1):70–81

70. Meheux CJ, McCulloch PC, Lintner DM, et al. Efficacy of intraarticular platelet-rich plasma injections in knee osteoarthritis: A systematic review. Arthroscopy. 2016 Mar;32(3):495-505. doi: 10.1016/j.arthro.2015.08.005. Epub 2015 Oct 1.

71. Shen L, Yuan T, Chen S, et al. The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res. 2017 Jan 23;12(1):16. doi: 10.1186/s13018-017-0521-3

72. Patel S, Dhillon MS, Aggarwal S, et al. Treatment with plateletrich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med. 2013 Feb;41(2):356-64. doi: 10.1177/0363546512471299. Epub 2013 Jan 8.

73. Cole BJ, Karas V, Hussey K, et al. Hyaluronic acid versus plateletrich plasma: A prospective, double-blind randomized controlled trial comparing clinical outcomes and effects on intra-articular biology for the treatment of knee osteoarthritis. Am J Sports Med. 2017 Feb;45(2):339-46. doi: 10.1177/0363546516665809. Epub 2016 Oct 21.

74. Filardo G, Di Matteo B, Di Martino A, et al. Platelet-rich plasma intra-articular knee injections show no superiority versus viscosupplementation: A randomized controlled trial. Am J Sports Med. 2015 Jul;43(7):1575-82. doi: 10.1177/0363546515582027. Epub 2015 May 7.

75. Joshi Jubert N, Rodriguez L, Reverte-Vinaixa MM, Navarro A. Platelet-rich plasma injections for advanced knee osteoarthritis: A prospective, randomized, double-blinded clinical trial. Orthop J Sports Med. 2017 Feb 13;5(2):2325967116689386. doi: 10.1177/2325967116689386. eCollection 2017 Feb.

76. Di Sante L, Villani C, Santilli V, et al. Intra-articular hyaluronic acid vs platelet-rich plasma in the treatment of hip osteoarthritis. Med Ultrason. 2016 Dec 5;18(4):463-8. doi: 10.11152/mu-874

77. Welch T, Mandelbaum B, Tom M. Autologous chondrocyte implantation: past, present, and future. Sports Med Arthrosc. 2016 Jun;24(2):85-91. doi: 10.1097/JSA.0000000000000115

78. Brittberg M, Lindahl A, Nilsson A, et al. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. 1994 Oct 6;331(14):889-95. doi: 10.1056/NEJM199410063311401

79. Phull AR, Eo SH, Abbas Q, et al. Applications of chondrocytebased cartilage engineering: An overview. Biomed Res Int. 2016;2016:1879837. doi: 10.1155/2016/1879837. Epub 2016 Aug 18.

80. Richter DL, Schenck RC Jr, Wascher DC, Treme G. Knee articular cartilage repair and restoration techniques: A review of the literature. Sports Health. 2016 Mar-Apr;8(2):153-60. doi: 10.1177/1941738115611350. Epub 2015 Oct 12.

81. Albright JC, Daoud AK. Microfracture and Microfracture Plus. Clin Sports Med. 2017 Jul;36(3):501-7. doi: 10.1016/j.csm.2017.02.012. Epub 2017 Apr 15.

82. Robert H. Chondral repair of the knee joint using mosaicplasty. Orthop Traumatol Surg Res. 2011 Jun;97(4):418-29. doi: 10.1016/j.otsr.2011.04.001. Epub 2011 May 23.

83. Vasiliadis HS, Wasiak J. Autologous chondrocyte implantation for full thickness articular cartilage defects of the knee. Cochrane Database Syst Rev. 2010 Oct 6;(10):CD003323. doi: 10.1002/14651858.CD003323.pub3

84. Gracitelli GC, Moraes VY, Franciozi CE, et al. Surgical interventions (microfracture, drilling, mosaicplasty, and allograft transplantation) for treating isolated cartilage defects of the knee in adults. Cochrane Database Syst Rev. 2016 Sep 3;9:CD010675 [Epub ahead of print].

85. Kraeutler MJ, Belk JW, Purcell JM, McCarty EC. Microfracture versus autologous chondrocyte implantation for articular cartilage lesions in the knee: A systematic review of 5-year outcomes. Am J Sports Med. 2017 Apr 1:363546517701912. doi: 10.1177/0363546517701912 [Epub ahead of print].

86. Saris D, Price A, Widuchowski W, et al. Matrix-applied characterized autologous cultured chondrocytes versus microfracture: Twoyear follow-up of a prospective randomized trial. Am J Sports Med. 2014 Jun;42(6):1384-94. doi: 10.1177/0363546514528093. Epub 2014 Apr 8.

87. Mistry H, Connock M, Pink J, et al. Autologous chondrocyte implantation in the knee: systematic review and economic evaluation. Health Technol Assess. 2017 Feb;21(6):1-294. doi: 10.3310/hta21060


Рецензия

Для цитирования:


Каратеев А.Е., Лила А.М. Остеоартрит: современная клиническая концепция и некоторые перспективные терапевтические подходы. Научно-практическая ревматология. 2018;56(1):70-81. https://doi.org/10.14412/1995-4484-2018-70-81

For citation:


Karateev A.E., Lila A.M. OSTEOARTHRITIS: CURRENT CLINICAL CONCEPT AND SOME PROMISING THERAPEUTIC APPROACHES. Rheumatology Science and Practice. 2018;56(1):70-81. (In Russ.) https://doi.org/10.14412/1995-4484-2018-70-81

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ISSN 1995-4484 (Print)
ISSN 1995-4492 (Online)