medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-2-100-106medsovet-6751Research ArticleРЕВМАТОЛОГИЯRHEUMATOLOGYЛокальная инъекционная терапия: применение гиалуроновой кислоты при остеоартрите и других заболеваниях суставовLocal injection therapy: the use of hyaluronic acid in osteoarthritis and other joint diseaseshttps://orcid.org/0000-0002-2985-8831ДыдыкинаИ. С.DydykinaI. S.

 к.м.н., ведущий научный сотрудник лаборатории эволюции ревматоидного артрита 

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

 Cand. Sci. (Med.), Leading Researcher, Laboratory for the Evolution of Rheumatoid Arthritis

34а, Kashirskoe Shosse, Moscow, 115522, Russia 

dydykina_is@mail.ruhttps://orcid.org/0000-0002-6076-4374КоваленкоП. С.KovalenkoP. S.

 к.м.н., младший научный сотрудник лаборатории мониторинга безопасности антиревматических препаратов 

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

 Cand. Sci. (Med.), Junior Researcher, Laboratory for Monitoring the Safety of Antirheumatic Drugs 

34а, Kashirskoe Shosse, Moscow, 115522, Russia 

polina_dydykina@mail.ruhttps://orcid.org/0000-0003-3431-5580АболешинаА. В.AboleshinaA. V.

 клинический ординатор 

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

 Medical Resident  

34а, Kashirskoe Shosse, Moscow, 115522, Russia 

abolyoshina@yandex.ruhttps://orcid.org/0000-0002-3333-0220КоваленкоА. А.KovalenkoA. A.

 к.м.н., главный врач Университетской клинической больницы №5 

119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2 

 Cand. Sci. (Med.), Chief Physician University Clinical Hospital No. 5

8, Bldg. 2, Trubetskaya St., Moscow, 119991, Russia 

alexey-kovalenko@yandex.ruНаучно-исследовательский институт ревматологии имени В.А. НасоновойРоссияNasonova Research Institute of RheumatologyRussian FederationПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation20221303202202100106Copyright © Дыдыкина И.С., Коваленко П.С., Аболешина А.В., Коваленко А.А., 20222022Дыдыкина И.С., Коваленко П.С., Аболешина А.В., Коваленко А.А.Dydykina I.S., Kovalenko P.S., Aboleshina A.V., Kovalenko A.A.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/6751

В статье обсуждается применение локальной инъекционной терапии (ЛИТ) в артрологической практике. Целью ЛИТ является введение лекарственного средства в полость сустава или периартикулярно, удаление избыточного количества синовиальной жидкости из полости сустава с последующим анализом его состава для проведения дифференциального диагноза и принятия решения о лечебной тактике. Наиболее часто используются при ЛИТ глюкокортикоиды, гиалуроновая кислота (ГлК), аутологичная обогащенная тромбоцитами плазма. Метод введения ГлК в полость сустава рассматривается экспертами как перспективный способ лечения остеоартрита, наиболее распространенного хронического заболевания суставов. Препараты на основе ГлК различаются между собой по концентрации, молекулярному весу и методике производства. В статье представлены результаты исследований с использованием высоко- или низкомолекулярных препаратов ГлК при лечении пациентов с остеоартритом коленных, тазобедренных и мелких суставов. Обращается внимание на то, что ЛИТ препаратами ГлК применяется при лечении других заболеваний костно-мышечной системы. Представлены данные, в т. ч. отечественных авторов, об эффективности ГлК при ОА плечевых суставов, при синдроме сдавления ротаторов плеча. Так, восстановление объема движений и значительное уменьшение боли в области плеча было достигнуто на фоне применения от 3 до 5 инъекций препарата ГлК, произведенного в Российской Федерации методом бактериальной ферментации. Уникальная технология производства препарата ГлК позволяет снизить риск содержания бактериальных эндотоксинов, полностью очистить раствор от гиалуронидазы, повысить однородность, сохранить молекулярную массу. На основании полученных доказательств эффективности и безопасности препараты ГлК включены различными медицинскими ассоциациями и профессиональными сообществами в российские и международные клинические рекомендации по лечению ОА.

The article deals with local injection therapy (LIT) in arthrological practice, the purpose of which is the introduction of a drug into the joint cavity or periarticularly, removal of excess synovial fluid from the joint cavity with subsequent analysis of its composition for differential diagnosis and decision-making on treatment tactics. The most commonly used in LIT are glucocorticoids, hyaluronic acid (GlK), autologous platelet-rich plasma. The method of introducing GLA into the joint cavity is considered by experts as a promising method for the treatment of osteoarthritis, the most common chronic joint disease. GlK-based preparations differ in concentration, molecular weight and production method. The article presents the results of studies using high- or low-molecular drugs GlK in the treatment of patients with osteoarthritis of the knee, hip and small joints. Attention is drawn to the fact that LIT with GlK preparations is used in the treatment of other diseases of the musculoskeletal system. Data are presented, including those of Russian authors, on the effectiveness of GlK in OA of the shoulder joints, in the syndrome of compression of the shoulder rotators. Thus, the restoration of range of motion and a significant reduction in pain in the shoulder area was achieved against the background of the use of 3 to 5 injections of the GlK preparation produced in the Russian Federation by bacterial fermentation. The unique production technology of the GlK preparation makes it possible to reduce the risk of bacterial endotoxins, completely purify the solution from hyaluronidase, increase homogeneity, and preserve the molecular weight. On the basis of the obtained evidence of efficacy and safety, HLA preparations are included by various medical associations and professional communities in Russian and international clinical guidelines for the treatment of OA.

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