medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-19-155-162medsovet-6544Research ArticleРЕВМАТОЛОГИЯRHEUMATOLOGYМесто внутрисуставного введения глюкокортикоидов: современные рекомендацииIntra-articular glucocorticoid injection site: best practice guidelineshttps://orcid.org/0000-0001-8051-8659ЧичасоваН. В.ChichasovaN. V.

Чичасова Наталия Владимировна, старший преподаватель учебно-методического отдела; д.м.н., профессор кафедры ревматологии

115522, Россия, Москва, Каширское шоссе, д. 34А

125993, Россия, Москва, ул. Баррикадная, д. 2/1, стр. 1

Natalia V. Chichasova, Senior Lecturer of the Educational and Methodological Department; Dr. Sci. (Med.), Professor of Rheumatology Department

34А, Kashirskoe Shosse, Moscow, 115522, Russia

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993, Russia

kafedrarheum@yandex.ruhttps://orcid.org/0000-0002-6068-3080ЛилаА. М.LilaA. M.

Лила Александр Михайлович, директор; д.м.н., профессор, заведующий кафедрой ревматологии

115522, Россия, Москва, Каширское шоссе, д. 34А

125993, Россия, Москва, ул. Баррикадная, д. 2/1, стр. 1

Aleksander M. Lila, Director; Dr. Sci. (Med.), Professor, Head of the Department of Rheumatology

34А, Kashirskoe Shosse, Moscow, 115522, Russia

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993, Russia

sokrat@irramn.ruНаучно-исследовательский институт ревматологии имени В.А. Насоновой; Российская медицинская академия непрерывного профессионального образованияРоссияNasonova Research Institute of Rheumatology; Russian Medical Academy of Continuous Professional EducationRussian Federation202130112021019155162Copyright © Чичасова Н.В., Лила А.М., 20212021Чичасова Н.В., Лила А.М.Chichasova N.V., Lila A.M.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/6544

В статье представлены современные рекомендации по использованию системного назначения глюкокортикоидов. Указывается, что просматривается четкая тенденция к минимизации доз и сроков назначения системных глюкокортикоидов при ревматоидном артрите, а при серонегативных спондилоартопатиях (анкилозирующий спондилит, псориатический артрит) в соответствии и с зарубежными, и отечественными рекомендациями системная терапия глюкокортикоидами не проводится. Подчеркивается, что на современном этапе возрастет роль локального введения глюкокортикоидов как эффективного способа уменьшения активности артрита при любой нозологической форме. Описаны механизмы действия локально вводимых глюкокортикоидов, приводящие к противовоспалительному и анальгетическому эффектам. Представлена сравнительная характеристика локально вводимых глюкокортикоидов с различной продолжительностью действия по их эффективности и безопасности. Описаны предикторы эффективности локальной терапии глюкокортикоидами. Приведены данные по оценке продолжительности противовоспалительного и анальгетического эффектов различных локальных глюкокортикоидов, в т. ч. и по сравнению с введением внутрисуставно препаратов гиалуроновой кислоты, которые показали преимущества бетаметазона перед триамцинолона ацетатом. Описаны различия в кристаллической структуре бетаметазона и триамцинолона ацетата. Указано, что меньший в 2,5 раза размер кристаллов бетаметазона, по сравнению с кристаллами триамцинолона ацетата, и отсутствие у кристаллов бетаметазона игольчатой формы позволяют использовать бетаметазон в лечении воспалительных процессов в периартикулярных тканях, а также при кристаллических артритах (подагра, псевдоподагра). Приведены данные по безопасности использования внутрисуставных инъекций глюкокортикоидов. Указано, что регистрация в РФ новой формы бетаметазона в преднаполненных шприцах в еще большей мере позволяет избежать инфекционных осложнений этого вида терапии. Описаны редкие случаи осложнений локальной терапии глюкокортикоидами.

The article presents modern recommendations for the use of systemic administration of glucocorticoids. It is indicated that there is a clear tendency to minimize the doses and timing of the appointment of systemic glucocorticoids in rheumatoid arthritis, and in seronegative spondyloarthropathies (ankylosing spondylitis, psoriatic arthritis), in accordance with both foreign and domestic recommendations, systemic therapy with glucocorticoids is not carried out. It is emphasized that at the present stage, the role of local administration of glucocorticoids will increase as an effective way to reduce the activity of arthritis in any nosologically form. The mechanisms of action of locally administered glucocorticoids leading to anti-inflammatory and analgesic effects are described. The comparative characteristics of locally administered glucocorticoids with different duration of action according to their effectiveness and safety are presented. Predictors of the effectiveness of local therapy with glucocorticoids are described. The data on the evaluation of the duration of the anti-inflammatory and analgesic effects of various local glucocorticoids, including in comparison with the intra-articular administration of hyaluronic acid preparations, which showed the advantages of betamethasone over triamcinolone acetate, are presented. The differences in the crystal structure of betamethasone and triamcinolone acetate are described. It is indicated that the 2.5-fold smaller size of betamethasone crystals compared to triamcinolone acetate crystals and the absence of betamethasone crystals makes it possible to use betamethasone in the treatment of inflammatory processes in periarticular tissues, as well as in crystalline arthritis (gout, pseudogout). The data on the safety of the use of intra-articular injection of glucocorticoids are presented. It is indicated that the registration in the Russian Federation of a new form of betamethasone in pre-filled syringes makes it even more possible to avoid infectious complications of this type of therapy. Rare cases of complications of local therapy with glucocorticoids are described.

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