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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">medsovet</journal-id><journal-title-group><journal-title xml:lang="ru">Медицинский Совет</journal-title><trans-title-group xml:lang="en"><trans-title>Meditsinskiy sovet = Medical Council</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2079-701X</issn><issn pub-type="epub">2658-5790</issn><publisher><publisher-name>REMEDIUM GROUP Ltd.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.21518/2079-701X-2020-11-164-176</article-id><article-id custom-type="elpub" pub-id-type="custom">medsovet-5766</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>РЕВМАТОЛОГИЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>RHEUMATOLOGY</subject></subj-group></article-categories><title-group><article-title>Стратегия лечения остеоартрита у мультиморбидных пациентов: баланс эффективности и безопасности при выборе лекарственной терапии</article-title><trans-title-group xml:lang="en"><trans-title>Strategy for the management of osteoarthritis in multimorbid patients: the balance of effectiveness and safety while choosing drug therapy</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-7856-1567</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Белова</surname><given-names>К. Ю.</given-names></name><name name-style="western" xml:lang="en"><surname>Belova</surname><given-names>K. Yu.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Белова Ксения Юрьевна, д.м.н., доцент кафедры терапии института последипломного образования; заведующая областным лечебно-диагностическим центром остеопороза и остеоартроза </p><p>150000, Ярославль, ул. Революционная, д. 5</p><p>150003, Ярославль, ул. Загородный Сад, д. 11</p></bio><bio xml:lang="en"><p>Kseniia Yu. Belova, Dr. of Sci. (Med.), associate Professor of the Department of therapy, Institute of postgraduate education; Head of Regional Treatment and Diagnostic Center of Osteoporosis and Osteoarthritis </p><p>5, Revolutsionnaya St., Yaroslavl, 150003</p><p>11, Zagorodny Sad St., Yaroslavl, 150000</p></bio><email xlink:type="simple">ksbelova@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-3198-5829</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Назарова</surname><given-names>А. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Nazarova</surname><given-names>A. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Назарова Анна Владимировна, к.м.н., врач-ревматолог областного лечебно-диагностического центра остеопороза и остеоартроза </p><p>150003, Ярославль, ул. Загородный Сад, д. 11</p></bio><bio xml:lang="en"><p>Anna V. Nazarova, Cand. of Sci. (Med.), Rheumatologist of Regional Treatment and Diagnostic Center of Osteoporosis and Osteoarthritis </p><p>11, Zagorodny Sad St., Yaroslavl, 150000</p></bio><email xlink:type="simple">nazanna@rambler.ru</email><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Ярославский государственный медицинский университет; Клиническая больница скорой медицинской помощи им. Н.В. Соловьева</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Yaroslavl State Medical University; Yaroslavl Regional Clinical emergency hospital named after N.V. Solovyov</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Клиническая больница скорой медицинской помощи им. Н.В. Соловьева</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Yaroslavl Regional Clinical emergency hospital named after N.V. Solovyov</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2020</year></pub-date><pub-date pub-type="epub"><day>07</day><month>08</month><year>2020</year></pub-date><volume>0</volume><issue>11</issue><fpage>164</fpage><lpage>176</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Белова К.Ю., Назарова А.В., 2020</copyright-statement><copyright-year>2020</copyright-year><copyright-holder xml:lang="ru">Белова К.Ю., Назарова А.В.</copyright-holder><copyright-holder xml:lang="en">Belova K.Y., Nazarova A.V.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.med-sovet.pro/jour/article/view/5766">https://www.med-sovet.pro/jour/article/view/5766</self-uri><abstract><p>В связи с увеличением продолжительности жизни растет число людей пожилого и старческого возраста, имеющих различные хронические заболевания. Одним из наиболее распространенных заболеваний опорно-двигательного аппарата является остеоартрит. Согласно существующим рекомендациям, среди всех медикаментозных препаратов ведущее место в терапии пациентов с остеоартритом отводится симптоматическим медленнодействующим препаратам (SYSADOA). Данные многочисленных исследований показывают, что нередко у пожилых пациентов наблюдается мультиморбидность, что значительно ограничивает назначение им многих лекарственных препаратов. В таких случаях применение препаратов из группы SYSADOA становится основой терапии благодаря их безопасности. К лекарственным средствам данной группы относятся хондроитина сульфат и глюкозамина сульфат. Они являются одними из основных структурных компонентов хряща и синовиальной жидкости, используются для синтеза гликозаминогликанов, уменьшают процессы деградации хряща, а также проявляют анальгетическое и противовоспалительное действие. Кроме того, был показан целый ряд дополнительных плейотропных эффектов этих препаратов, включающих положительное влияние на состояние мышц при саркопении, на снижение риска смертности от некоторых онкологических заболеваний и осложнений сахарного диабета. В последние годы появились также данные о применении препарата натуральной яичной мембраны (NEM), содержащего естественные гликозаминогликаны и белки, необходимые для поддержания состояния хряща и синовиальной оболочки. В исследованиях было показано его противовоспалительное действие, снижение интенсивности боли и улучшение функциональных показателей у пациентов с остеоартритом. Также было отмечено уменьшение продукции провоспалительных цитокинов при остеоартрите для вещества растительного происхождения гарпагофитума, которое имеет терапевтический потенциал в лечении заболеваний, связанных с воспалением и окислительным стрессом.</p></abstract><trans-abstract xml:lang="en"><p>Due to the increase in life expectancy, the number of elderly and senile people with various chronic diseases is growing. One of the most common diseases of the musculoskeletal system is osteoarthritis. According to existing recommendations among all medications the leading place in the treatment of patients with osteoarthritis is given to symptomatic slowacting drugs (SYSADOA). Data from numerous studies show that these patients are often multimorbid, and this fact significantly restricts the appointment of many medications. In such cases, the use of drugs from the SYSADOA group becomes the basis of therapy due to their safety. Medications of this group include chondroitin sulfate and glucosamine sulfate. They are the main structural components of cartilage and synovial fluid and they are used for the synthesis of glycosaminoglycans, they reduce the degradation of cartilage, and also exhibit analgesic and anti-inflammatory effects. In addition, a number of other pleiotropic effects of these drugs have been shown, including a positive effect on muscles in sarcopenia, on reducing the risk of death from several cancers and complications of diabetes mellitus. In recent years, there has also been evidence of the use of the natural egg membrane preparation (NEM), which contains natural glycosaminoglycans and proteins necessary for maintaining the condition of the cartilage and synovial membrane. Studies have shown its anti-inflammatory effect, reducing the intensity of pain and improving functional indicators in patients with osteoarthritis. There was also a decrease in the production of pro-inflammatory cytokines in osteoarthritis for the plant-derived substance harpagophytum, which has therapeutic potential in the treatment of diseases associated with inflammation and oxidative stress.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>остеоартрит</kwd><kwd>мультиморбидность</kwd><kwd>SYSADOA</kwd><kwd>хондроитина сульфат</kwd><kwd>NEM-комплекс</kwd><kwd>гарпагофитум</kwd></kwd-group><kwd-group xml:lang="en"><kwd>osteoarthritis</kwd><kwd>multimorbidity</kwd><kwd>SYSADOA</kwd><kwd>chondroitin sulfate</kwd><kwd>NEM-complex</kwd><kwd>harpagophytum</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. 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