Остеоартрит «нетипичной» локализации: эпидемиология, клинические проявления, принципы терапии

Проблема остеоартрита (ОА), самого частого хронического ревматического заболевания, обычно рассматривается в отношении трех групп суставов – коленных, тазобедренных и кистей. Однако ОА может поражать любые суставы человеческого организма, вызывая характерные для данной нозологической формы патологические изменения: связанную с механическим стрессом деструкцию ткани сустава, хроническое воспаление и дегенеративные процессы (неоангиогенез, фиброз, гетеротопическая оссификация). В настоящем обзоре рассмотрены пять «нетипичных» локализаций ОА – плечевой, акромиально-ключичный, локтевой, голеностопный суставы и суставы стопы. Их поражение наблюдается достаточно часто: плечевого – примерно у 15%, голеностопного – у 3–5%, суставов стопы – у 17% современной популяции. Основными факторами риска ОА данной локализации являются травмы, повторяющаяся значительная нагрузка, нестабильность и деформации суставов. Клиника типична для ОА и проявляется «механическими» и «стартовыми» болями, скованностью, нарастающим нарушением функции, хрустом и деформацией. В ряде случаев отмечается стойкий синовит, сопровождающийся болями в покое и ночью. Общепризнанные критерии ОА «нетипичной» локализации пока не разработаны, поэтому его диагностика проводится на основании наличия характерных жалоб, типичных рентгенологических изменений (сужение суставной щели, субхондральный склероз, остеофиты) и исключения иной патологии, способной вызвать поражение сустава. Лечение должно носить комплексный характер и включать комбинированное применение немедикаментозных методов (ортезирование, лечебная физкультура, физиотерапия) и фармакологических средств, таких как нестероидные противовоспалительные препараты, медленнодействующие симптоматические средства и локальная инъекционная терапия (внутрисуставное введение глюкокортикоидов, гиалуроновой кислоты, обогащенной тромбоцитами плазмы). При неэффективности консервативной терапии используется широкий спектр хирургических вмешательств – от артроскопической хондропластики до тотального эндопротезирования.

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