medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-10-140-146medsovet-6276Research ArticleРЕВМАТОЛОГИЯRHEUMATOLOGYРевматоидный артрит в менопаузе: вопросов больше, чем ответовRheumatoid arthritis of menopause: there are more questions than answershttps://orcid.org/0000-0001-7591-6281ХашукоеваА. З.KhashukoevaA. Z.

Хашукоева Асият Зульчифовна - доктор медицинских наук, профессор, профессор кафедры акушерства и гинекологии лечебного факультета.

117997, Москва, ул. Островитянова, д. 1

Asiyat Z. Khashukoeva, Dr. Sci. (Med.), Professor, Professor of the Department of Obstetrics and Gynecology, Faculty of General Medicine.

1, Ostrovityanov St., Moscow, 117997

azk05@mail.ruhttps://orcid.org/0000-0002-6253-621XНаумовА. В.NaumovA. V.

Наумов Антон Вячеславович - доктор медицинских наук, профессор кафедры болезней старения, РНИМУ имени Н.И. Пирогова; заведующий лабораторией заболеваний костно-мышечной системы, РГНКЦ.

117997, Москва, ул. Островитянова, д. 1; 129226, Москва, ул. 1-я Леонова, д. 16

Anton V. Naumov, Dr. Sci. (Med.), Professor, Professor of the Department of Aging Diseases, Pirogov RNRMU; Head of the Laboratory of Diseases of the Musculoskeletal System, RGRCC.

1, Ostrovityanov St., Moscow, 117997; 16, 1st Leonov St., Moscow, 129226

nanton78@gmail.comМешковА. Д.MeshkovA. D.

Мешков Алексей Дмитриевич - кандидат медицинских наук, врач-ревматолог, старший научный сотрудник лаборатории заболеваний костно-мышечной системы.

129226, Москва, ул. 1-я Леонова, д. 16

Aleksey D. Meshkov, Cand. Sci. (Med.), Rheumatologist, Senior Researcher of the Laboratory of Diseases of the Musculoskeletal System.

16, 1st Leonov St., Moscow, 129226

alexeymeshkov@mail.ruРассохинаО. В.RassokhinaO. V.

Рассохина Олеся Валентиновна - клинический ординатор кафедры акушерства и гинекологии лечебного факультета.

117997, Москва, ул. Островитянова, д. 1

Olesya V. Rassokhina, Clinical Resident of the Department of Obstetrics and Gynecology, Faculty of General Medicine.

1, Ostrovityanov St., Moscow, 117997

olesya.babariko@bk.ruРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова; Российский геронтологический научно-клинический центрРоссияPirogov Russian National Research Medical University; Russian Gerontological Research and Clinical CenterRussian FederationРоссийский геронтологический научно-клинический центрРоссияRussian Gerontological Research and Clinical CenterRussian Federation202107082021010140146Copyright © Хашукоева А.З., Наумов А.В., Мешков А.Д., Рассохина О.В., 20212021Хашукоева А.З., Наумов А.В., Мешков А.Д., Рассохина О.В.Khashukoeva A.Z., Naumov A.V., Meshkov A.D., Rassokhina O.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6276

Статья посвящена актуальной проблеме - ревматоидному артриту (РА), симптомы которого манифестируют у женщин в период перименопаузы. Как свидетельствуют литературные данные, зачастую именно в период угнетения репродуктивной функции у женщин заболевание впервые проявляет себя. РА существенно влияет на прогноз ожидаемой продолжительности жизни женщины и ее качество. Клинические и патогенетические взаимосвязи аутоиммунных заболеваний (одним из которых является РА) и особенностей менопаузы изучены недостаточно и нуждаются в исследовании. В основном работы, посвященные проблеме, представляют собой эпидемиологические исследования и изучение взаимосвязей уровней половых гормонов и медиаторов воспаления, специфичных для РА.

Представленный литературный обзор об особенностях дебюта и течения заболевания у женщин в менопаузе посвящен физиологическим предпосылкам и механизмам развития РА у женщин в период менопаузы. Наиболее принятыми в литературе объяснениями, характеризующими взаимосвязь изменений при менопаузе и РА, являются доводы о протективном действии эстрогенов на клетки костно-мышечной системы и возможностях эстрогенов влиять на интенсивность инфламейджинга (системного воспаления низкой интенсивности, связанного с возрастом). В случае развития РА в пожилом возрасте выявляются более высокие показатели ИЛ-6 и более низкие - ФНО-а. Этот факт дает основание для выбора базисной терапии в пользу гуманизированного моноклонального антитела к человеческому рецептору интерлейкина-6 - тоцилизумаба.

Обзор может быть интересен как практикующим ревматологам, неврологам, так и гинекологам и врачам общей практики.

The article is devoted to an urgent issue - rheumatoid arthritis (RA). The symptoms of arthritis appear in women during menopause. Literature data show that it is often during period of poor reproductive function that the disease first manifests itself in women. RA significantly affects the prognosis of women’s life expectancy and quality. The clinical and pathogenetic relationships between autoimmune diseases (one of which is RA) and the features of menopause remain poorly understood and require research. Basically, papers devoted to the problem present epidemiological studies and the study of the relationships between sex hormones levels and inflammatory mediators that are specific to RA.

A literature review on the features of the onset and course of rheumatoid arthritis in menopausal women is presented. The most accepted in the literature explanations characterizing the relationship between changes during menopause and RA are arguments about the protective effect of estrogens on the cells of the musculoskeletal system and the ability of estrogens to influence the intensity of inflammation (systemic inflammation of low intensity associated with age). In the case of the development of rheumatoid arthritis in old age, higher levels of IL-6 and lower TNFa are revealed. This fact gives rise to the choice of basic therapy in favor of a humanized monoclonal antibody to the human interleukin-6 receptor - tocilizumab.

The review may be of interest to both practising rheumatologists, neurologists, and gynecologists and general practitioners.

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