medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2019-21-224-230medsovet-5498Research ArticleПрактикаPracticeКлиническое значение отека костного мозга на поздних стадиях остеоартритаClinical significance of bone marrow edema in the late stages of osteoarthritishttps://orcid.org/0000-0002-3163-102XСнигиреваА. В.SnigirevaA. V.

Снигирева Анна Владимировна, к.м.н., доцент кафедры госпитальной терапии с профпатологией

150000, Россия, Ярославль, ул. Революционная, д. 5

 

5, Revolutsionnaya St., Yaroslavl, Russia, 150000

n0613@yandex.ruhttps://orcid.org/0000-0003-3456-9409НосковС. М.NoskovS. M.

Носков Сергей Михайлович, д.м.н., профессор, заведующий кафедрой госпитальной терапии с профпатологией

150000, Россия, Ярославль, ул. Революционная, д. 5

 

5, Revolutsionnaya St., Yaroslavl, Russia, 150000

noskov03@gmail.comhttps://orcid.org/0000-0003-3260-5672МаксимовМ. Л.MaksimovM. L.

Максимов Максим Леонидович, д.м.н., заведующий кафедрой клинической фармакологии и фармакотерапии; профессор кафедры фармакологии педиатрического факультета

420012, Россия, Казань, ул. Муштари, д. 11

117997, Россия, Москва, ул. Островитянова, д. 1

Maxim L. Maksimov, Dr. of Sci. (Med.), Head of the Department of Clinical Pharmacology and Pharmacotherapy; Professor, Department of Pharmacology, Paediatric Faculty

11, Musthari St., Kazan, 420012, Russia

1, Ostrovityanova St., Moscow, 117997, Russia

maksim_maksimov@mail.ruЯрославский государственный медицинский университетРоссияYaroslavl State Medical UniversityRussian FederationКазанская государственная медицинская академия – филиал Российской медицинской академии непрерывного профессионального образования; Российский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияKazan State Medical Academy, a branch of the Federal State Budgetary Educational Institution of Additional Professional Education «Russian Medical Academy of Continuous Professional Education» of the Ministry of Health of the Russian Federation; Federal State Budgetary Educational Institution of Higher Education «Russian National Research Medical University named after N.I. Pirogov» of the Ministry of Health of the Russian FederationRussian Federation201927012020021224230Copyright © Снигирева А.В., Носков С.М., Максимов М.Л., 20202020Снигирева А.В., Носков С.М., Максимов М.Л.Snigireva A.V., Noskov S.M., Maksimov M.L.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5498

Применение магнитно-резонансной томографии (МРТ) при остеоартрите позволило одномоментно детализировать состояние хряща, субхондральной кости, менисков, связок, синовиальной оболочки. В ряде исследований была обнаружена взаимосвязь отека костного мозга (ОКМ) и интенсивности болевого синдрома, прогрессирования ОА, риска тотального эндопротезирования коленных суставов. В других исследованиях достоверной связи ОКМ с клиническими проявлениями ОА не было выявлено. Высказано мнение, что ОКМ при ОА, приводящий к изнурительным болям, не связан с травмой и определяется увеличением внеклеточной жидкости. При анализе МРТ-изображений коленных суставов 80 пациентов с 1–3 рентгенологической стадией остеоартрита коленных суставов обнаружена статистически достоверная зависимость между наличием отека костного мозга и толщиной хряща бедренной и большеберцовой кости, разрывом и деградацией медиальных менисков, наличием кист Бейкера и утолщением синовиальной оболочки. Не обнаружено достоверной связи с наличием и выраженностью синовита. Представлен обзор данных о влиянии различных методов консервативной терапии на отек костного мозга при остеоартрите. Витамин D не оказывал положительного влияния на ОКМ. Золедроновая кислота достоверно воздействовала на ОКМ и величину боли. При сравнении влияния простациклина (Илопрост) и бисфосфосфанатов (Бондронат) на клиническую и МРТ- картину ОА коленных суставов улучшение показателей было больше в группе простациклина, чем в группе бисфосфоната, однако разница не была существенной. В целом применение основных антиостеопорозных препаратов не выявило качеств, обосновывающих их применение в лечении ОА. Таким образом, ОКМ представляет интерес как с точки зрения патогенеза ОА, так и как показатель эффективности проводимой терапии ОА. Полученные нами данные демонстрируют большую частоту встречаемости ОКМ на поздних стадиях ОА. Влияние фармакологических методов терапии на ОКМ требует дальнейшего изучения.

Влияние фармакологических методов терапии на ОКМ требует дальнейшего изучения.

The use of magnetic resonance imaging (MRI) for osteoarthritis made it possible to simultaneously detail the state of cartilage, subchondral bone, menisci, ligaments, and synovial membrane. In some studies, a correlation was found between bone marrow edema (BME) and the intensity of the pain syndrome, the progression of OA and the risk of total knee replacement. In other studies, these data were not confirmed. It has been suggested that BME in OA, leading to debilitating pain, is not associated with trauma and is determined by an increase in extracellular fluid. Analysis of MRI images of 80 patients with 1-3 stages of knee osteoarthritis revealed a statistically significant relationship between the presence of bone marrow edema and the thickness of the cartilage of the femur and tibia, rupture and degradation of the medial menisci, the presence of Baker cysts and thickening of the synovial membrane. No reliable relationship was found with the presence and severity of synovitis. A review of data on the effect of various methods of conservative therapy on bone marrow edema in osteoarthritis is presented. The effect of anti-osteoporotic drugs, prostacyclin, Pentosan polysulfate sodium chondroitin sulfate is considered. Thus, OKM is of interest both in terms of the pathogenesis of OA and as an indicator of the effectiveness of the treatment of OA. Our data demonstrate a high incidence of OKM in the late stages of OA. The effect of pharmacological therapies on OKM requires further study.

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