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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-2021-10-123-132</article-id><article-id custom-type="elpub" pub-id-type="custom">medsovet-6274</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>Терапевтическая ниша производных гиалуроновой кислоты при остеоартрозе</article-title><trans-title-group xml:lang="en"><trans-title>Therapeutic niche of hyaluronic acid derivatives in osteoarthritis</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0592-2616</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Красивина</surname><given-names>И. Г.</given-names></name><name name-style="western" xml:lang="en"><surname>Krasivina</surname><given-names>I. G.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Красивина Ирина Геннадьевна - доктор медицинских наук, доцент кафедры госпитальной терапии с профпатологией.</p><p>150000, Ярославль, ул. Революционная, д. 5</p></bio><bio xml:lang="en"><p>Irina G. Krasivina, Dr. Sci. (Med.), Associate Professor of the Department of Hospital Therapy with Occupational Pathology.</p><p>5, Revolyutsionnaya St., Yaroslavl, 150000</p></bio><email xlink:type="simple">ikrasivina@yandex.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/0000-0003-0244-9699</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Долгова</surname><given-names>Л. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Dolgova</surname><given-names>L. N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Долгова Лидия Николаевна - доктор медицинских наук, заместитель главного врача, КБ РЖД-Медицина г. Ярославль; ассистент кафедры поликлинической терапии, клинической лабораторной диагностики и медицинской биохимии, ЯрГМУ.</p><p>150031, Ярославль, Суздальское шоссе, д. 21; 150000, Ярославль, ул. Революционная, д. 5</p></bio><bio xml:lang="en"><p>Lidiya N. Dolgova, Dr. Sci. (Med.), Deputy Chief Medical Officer, CHR ZD-Medicine of the city of Yaroslavl; Assistant of the Department of Outpatient Therapy, Clinical Laboratory Diagnostics and Medical Biochemistry, Yaroslavl SMU.</p><p>21, Suzdalskoe Shosse, Yaroslavl, 150031; 5, Revolyutsionnaya St., Yaroslavl, 150000</p></bio><email xlink:type="simple">L.Dolgova@dkb.yar.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-2181-9325</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Долгов</surname><given-names>Н. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Dolgov</surname><given-names>N. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Долгов Николай Владимирович – терапевт.</p><p>150031, Ярославль, Суздальское шоссе, д. 21</p></bio><bio xml:lang="en"><p>Nikolay V. Dolgov, Therapist.</p><p>21, Suzdalskoe Shosse, Yaroslavl, 150031</p></bio><email xlink:type="simple">dolgov64942@yandex.ru</email><xref ref-type="aff" rid="aff-3"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Ярославский государственный медицинский университет</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Yaroslavl State Medical University</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Ярославский государственный медицинский университет; Клиническая больница РЖД-Медицина города Ярославль</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Yaroslavl State Medical University; Clinical Hospital RZD-Medicine of the city of Yaroslavl</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>Клиническая больница РЖД-Медицина города Ярославль</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Clinical Hospital RZD-Medicine of the city of Yaroslavl</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2021</year></pub-date><pub-date pub-type="epub"><day>07</day><month>08</month><year>2021</year></pub-date><volume>0</volume><issue>10</issue><fpage>123</fpage><lpage>132</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Красивина И.Г., Долгова Л.Н., Долгов Н.В., 2021</copyright-statement><copyright-year>2021</copyright-year><copyright-holder xml:lang="ru">Красивина И.Г., Долгова Л.Н., Долгов Н.В.</copyright-holder><copyright-holder xml:lang="en">Krasivina I.G., Dolgova L.N., Dolgov N.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/6274">https://www.med-sovet.pro/jour/article/view/6274</self-uri><abstract><p>Остеоартрит (ОА) - широко распространенное заболевание синовиальных суставов, в лечении которого определяется значительное количество тактических и стратегических направлений. В настоящее время накоплен опыт локального использования так называемых протезов синовиальной жидкости (СЖ), представляющих собой вязкоэластические субстанции, способствующие улучшению амортизационных свойств нативной внутрисуставной среды. Подавляющее большинство вязкоэластических добавок представлены производными гиалуроновой кислоты (ГК) - естественного компонента СЖ, биологическая роль которого заключается в поддержании реологических свойств СЖ, наличии противовоспалительного, антиноцицептивного и хон-дропротективного потенциалов. При разработке препаратов ГК основными целями являются устойчивое и контролируемое высвобождение терапевтических доз лекарственного средства с учетом выбора носителя, молекулы лекарственного средства и суставной ткани-мишени. Оценка качества и физиологической целесообразности введения в сустав конкретного вязкоупругого препарата предполагает определение так называемой частоты перекреста - точки пересечения модуля вязкости G’ и модуля упругости G” (G’/G”), что отражает изменения вязкоупругих свойств СЖ при увеличении частоты нагрузки при переходе от ходьбы к бегу. Физиологическому диапазону частот из большинства исследованных медицинских изделий соответствуют единичные, среди которых присутствуют и варианты отечественного производства. Проведенные многочисленные исследования локального применения некоторых препаратов ГК у больных ОА подтверждают их эффективность и безопасность, в частности уменьшение болевого синдрома, снижение потребности в нестероидных противовоспалительных средствах, улучшение качества жизни. Однако большинство доступных на рынке препаратов ГК, к сожалению, не проходили полноценных клинических испытаний, поэтому остается необходимость изучения сравнительной эффективности разрешенных к применению препаратов данной группы и определение их места в терапии ОА с различными вариантами течения.</p></abstract><trans-abstract xml:lang="en"><p>Osteoarthritis (OA) is a widespread disease of synovial joints, the treatment of which determines a significant number of tactical and strategic directions. Currently, there is experience in the local use of so-called synovial fluid (SF) prostheses, which are viscoelastic substances that improve the cushioning properties of the native intra-articular environment. The overwhelming majority of viscoelastic additives are represented by hyaluronic acid (HA) derivatives, a natural component of SF, whose biological role consists in maintaining the rheological properties of fluid and the presence of anti-inflammatory, anti-nociceptive and chondro-protective properties. In the development of HA drugs, the main goals are the sustained and controlled release of therapeutic doses of the drug, taking into account the choice of carrier, drug molecule and target articular tissue. Assessing the quality and physiological feasibility of introducing a particular viscoelastic drug into the joint involves determining the so-called crossover frequency - the point of intersection of the viscosity modulus G’ and the elastic modulus G” (G’/G”), which reflects changes in the viscoelastic properties of the SF with increasing load frequency when transitioning from walking to running. Physiological range of frequencies out of the majority of investigated medical products corresponds to a single one, among which there are also variants of domestic production. Numerous studies of local application of some HA drugs in patients with OA confirm their effectiveness and safety, in particular, reduction of pain syndrome, reduction of the need for nonsteroidal anti-inflammatory drugs, improvement of the quality of life. However, unfortunately, most HA drugs available on the market have not undergone full-fledged clinical trials, so there is a need to study the comparative effectiveness of drugs of this group approved for use and determine their place in the treatment of OA with different variants of the course.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>остеоартроз</kwd><kwd>синовиальная жидкость</kwd><kwd>модуль вязкости</kwd><kwd>модуль упругости</kwd><kwd>частота перекреста</kwd><kwd>гиалуро-новая кислота</kwd><kwd>локальное введение</kwd></kwd-group><kwd-group xml:lang="en"><kwd>osteoarthritis</kwd><kwd>synovial fluid</kwd><kwd>viscosity modulus</kwd><kwd>elastic modulus</kwd><kwd>crossing frequency</kwd><kwd>hyaluronic acid</kwd><kwd>local injection</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">Алексеева Л.И., Таскина Е.А., Кашеварова Н.Г Остеоартрит: эпидемиология, классификация, факторы риска и прогрессирования, клиника, диагностика, лечение. 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