medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-117medsovet-9007Research ArticleРЕВМАТОЛОГИЯRHEUMATOLOGYВозможности оптимизации терапии при метаболическом фенотипе остеоартритаOpportunities for optimizing therapy in the metabolic phenotype of osteoarthritishttps://orcid.org/0000-0003-3509-1072БашковаИ. Б.BashkovaI. B.

Башкова Инна Борисовна - к.м.н., доцент, доцент кафедры госпитальной терапии, Чувашский государственный университет имени И.Н. Ульянова; врач-ревматолог, Федеральный центр травматологии, ортопедии и эндопротезирования (г. Чебоксары).

428015, Чувашская Республика, Чебоксары, Московский проспект, д. 15; 428020, Чувашская Республика, Чебоксары, ул. Федора Гладкова, д. 33

Inna B. Bashkova - Cand. Sci. (Med.), Associate Professor, Associate Professor of the Department of Hospital Therapy, Chuvash SU named after I.N. Ulyanov; Rheumatologist, Federal Center for Traumatology, Orthopedics and Arthroplasty (Cheboksary).

15, Moskovsky Ave., Cheboksary, Chuvash Republic, 428015; 33, Fedor Gladkov St., Cheboksary, Chuvash Republic, 428020

innabashkova@yandex.ruhttps://orcid.org/0000-0001-7313-0365БусалаеваЕ. И.BusalaevaE. I.

Бусалаева Елена Исааковна - к.м.н., доцент, доцент кафедры госпитальной терапии, Чувашский государственный университет имени И.Н. Ульянова; доцент кафедры терапии и семейной медицины, Институт усовершенствования врачей;

428015, Чувашская Республика, Чебоксары, Московский проспект, д. 15; 428018, Чувашская Республика, Чебоксары, ул. Михаила Сеспеля, д. 27

Elena I. Busalaeva - Cand. Sci. (Med.), Associate Professor, Associate Professor of the Department of Hospital Therapy, Chuvash SU named after I.N. Ulyanov; Associate Professor of the Department of Therapy and Family Medicine, Institute for Advanced Training of Doctors.

15, Moskovsky Ave., Cheboksary, Chuvash Republic, 428015; 27, Mikhail Sespel St., Cheboksary, Chuvash Republic, 428018

busa-elena@yandex.ruЧувашский государственный университет имени И.Н. Ульянова; Федеральный центр травматологии, ортопедии и эндопротезирования (г. Чебоксары)РоссияChuvash State University named after I.N. Ulyanov; Federal Center for Traumatology, Orthopedics and Arthroplasty (Cheboksary)Russian FederationЧувашский государственный университет имени И.Н. Ульянова; Институт усовершенствования врачейРоссияChuvash State University named after I.N. Ulyanov; Institute for Advanced Training of DoctorsRussian Federation20251204202503134143Copyright © Башкова И.Б., Бусалаева Е.И., 20252025Башкова И.Б., Бусалаева Е.И.Bashkova I.B., Busalaeva E.I.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/9007

Остеоартрит (ОА) представляет собой крайне неоднородное (гетерогенное) заболевание. Выделение определенного фенотипа заболевания поможет практикующему врачу оптимизировать подходы к диагностике и лечению. Метаболический фенотип ОА ассоциируется с самой большой полии коморбидностью, которая будет существенно ограничивать выбор ряда препаратов, часто используемых в терапии данной суставной патологии. Приведенное клиническое наблюдение демонстрирует сложности в курации пациентки, имеющей сочетание одиннадцати соматических заболеваний одновременно, одним из которых явился ОА. Тактика ведения предполагает, с одной стороны, обоснованную полипрагмазию, с другой – низкую приверженность к длительному применению большого количества лекарственных средств, а наличие многих коморбидных заболеваний, в частности ишемической болезни сердца и перенесенного инсульта, предполагает полный отказ от применения нестероидных противовоспалительных препаратов (за исключением локальных форм). Регулярное проведение в последние два года парентеральной терапии биоактивным экстрактом из мелкой морской рыбы позволило достичь клинического улучшения и, вероятно, не допустить рентгенографического прогрессирования ОА коленных суставов, а также отсрочить выполнение операции по замене сустава.

Osteoarthritis (OA) is an extremely heterogeneous disease. Identifying a specific disease phenotype will help the practitioner optimize approaches to diagnosis and treatment. The metabolic phenotype of OA is associated with the greatest polyand comorbidity, which will significantly limit the choice of a number of drugs often used in the treatment of this joint pathology. The presented clinical observation demonstrates the difficulties in the care of a patient with a combination of eleven somatic diseases at the same time, one of which was OA. Care tactics suggest, on the one hand, justified polypragmasy, on the other hand, low adherence to long–term use of a large number of drugs. The presence of many comorbid diseases, in particular coronary heart disease, and history of stroke, suggest a complete rejection of the use of nonsteroidal anti-inflammatory drugs (with the exception of local forms). Regular therapy with a bioactive extract from small marine fish in the last two years has made it possible to achieve clinical improvement and, probably, prevent radiographic progression of knee joint OA and delay joint replacement surgery.

остеоартритожирениекоморбидностьметаболический фенотипобоснованная полипрагмазиябиоактивный экстракт из мелкой морской рыбынестероидные противовоспалительные препаратыosteoarthritisobesitycomorbiditymetabolic phenotypeproven polypragmasiabioactive extract from small marine fishnonsteroidal anti-inflammatory drugsReferencesRudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200–211. https://doi.org/10.1016/S0140-6736(19)32989-7.Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200–211. https://doi.org/10.1016/S0140-6736(19)32989-7.Каратеев ДЕ. Современные тенденции патогенетической терапии остеоартрита. Эффективная фармакотерапия. 2023;19(9):38–46. Режим доступа: https://elibrary.ru/zrqudr.Karateev DE. Modern trends of pathogenetic therapy of osteoarthritis. Effective Pharmacotherapy. 2023;19(9):38–46. (In Russ.) Available at: https://elibrary.ru/zrqudr.Marcianò G, Vocca C, Rania V, Citraro R, De Sarro G, Gallelli L. Metalloproteases in Pain Generation and Persistence: A Possible Target? Biomolecules. 2023;13(2):268. https://doi.org/10.3390/biom13020268.Marcianò G, Vocca C, Rania V, Citraro R, De Sarro G, Gallelli L. Metalloproteases in Pain Generation and Persistence: A Possible Target? Biomolecules. 2023;13(2):268. https://doi.org/10.3390/biom13020268.Yao Q, Wu X, Tao C, Gong W, Chen M, Qu M et al. Osteoarthritis: pathogenic signaling pathways and therapeutic targets. Signal Transduct Target Ther. 2023;8(1):56. https://doi.org/10.1038/s41392-023-01330-w.Yao Q, Wu X, Tao C, Gong W, Chen M, Qu M et al. Osteoarthritis: pathogenic signaling pathways and therapeutic targets. Signal Transduct Target Ther. 2023;8(1):56. https://doi.org/10.1038/s41392-023-01330-w.Hu W, Chen Y, Dou C, Dong S. Microenvironment in subchondral bone: predominant regulator for the treatment of osteoarthritis. Ann Rheum Dis. 2021;80(4):413–422. https://doi.org/10.1136/annrheumdis-2020-218089.Hu W, Chen Y, Dou C, Dong S. Microenvironment in subchondral bone: predominant regulator for the treatment of osteoarthritis. Ann Rheum Dis. 2021;80(4):413–422. https://doi.org/10.1136/annrheumdis-2020-218089.Lacourt M, Gao C, Li A, Girard C, Beauchamp G, Henderson JE, Laverty S. Relationship between cartilage and subchondral bone lesions in repetitive impact trauma-induced equine osteoarthritis. Osteoarthritis Cartilage. 2012;20(6):572–583. https://doi.org/10.1016/j.joca.2012.02.004.Lacourt M, Gao C, Li A, Girard C, Beauchamp G, Henderson JE, Laverty S. Relationship between cartilage and subchondral bone lesions in repetitive impact trauma-induced equine osteoarthritis. Osteoarthritis Cartilage. 2012;20(6):572–583. https://doi.org/10.1016/j.joca.2012.02.004.Ulivi V, Giannoni P, Gentili C, Cancedda R, Descalzi F. p38/NF-kB-dependent expression of COX-2 during differentiation and inflammatory response of chondrocytes. J Cell Biochem. 2008;104(4):1393–1406. https://doi.org/10.1002/jcb.21717.Ulivi V, Giannoni P, Gentili C, Cancedda R, Descalzi F. p38/NF-kB-dependent expression of COX-2 during differentiation and inflammatory response of chondrocytes. J Cell Biochem. 2008;104(4):1393–1406. https://doi.org/10.1002/jcb.21717.Jung YK, Han MS, Park HR, Lee EJ, Jang JA, Kim GW et al. Calciumphosphate complex increased during subchondral bone remodeling affects earlystage osteoarthritis. Sci Rep. 2018;8(1):487. https://doi.org/10.1038/s41598-017-18946-y.Jung YK, Han MS, Park HR, Lee EJ, Jang JA, Kim GW et al. Calciumphosphate complex increased during subchondral bone remodeling affects earlystage osteoarthritis. Sci Rep. 2018;8(1):487. https://doi.org/10.1038/s41598-017-18946-y.De Palma A, Nalesso G. WNT Signalling in Osteoarthritis and Its Pharmacological Targeting. Handb Exp Pharmacol. 2021;269:337–356. https://doi.org/10.1007/164_2021_525.De Palma A, Nalesso G. WNT Signalling in Osteoarthritis and Its Pharmacological Targeting. Handb Exp Pharmacol. 2021;269:337–356. https://doi.org/10.1007/164_2021_525.De Santis M, Di Matteo B, Chisari E, Cincinelli G, Angele P, Lattermann C et al. The Role of Wnt Pathway in the Pathogenesis of OA and Its Potential Therapeutic Implications in the Field of Regenerative Medicine. Biomed Res Int. 2018;2018:7402947. https://doi.org/10.1155/2018/7402947.De Santis M, Di Matteo B, Chisari E, Cincinelli G, Angele P, Lattermann C et al. The Role of Wnt Pathway in the Pathogenesis of OA and Its Potential Therapeutic Implications in the Field of Regenerative Medicine. Biomed Res Int. 2018;2018:7402947. https://doi.org/10.1155/2018/7402947.Scanzello CR. Role of low-grade inflammation in osteoarthritis. Curr Opin Rheumatol. 2017;29(1):79–85. https://doi.org/10.1097/BOR.0000000000000353.Scanzello CR. Role of low-grade inflammation in osteoarthritis. Curr Opin Rheumatol. 2017;29(1):79–85. https://doi.org/10.1097/BOR.0000000000000353.Mathiessen A, Conaghan PG. Synovitis in osteoarthritis: current understanding with therapeutic implications. Arthritis Res Ther. 2017;19(1):18. https://doi.org/10.1186/s13075-017-1229-9.Mathiessen A, Conaghan PG. Synovitis in osteoarthritis: current understanding with therapeutic implications. Arthritis Res Ther. 2017;19(1):18. https://doi.org/10.1186/s13075-017-1229-9.Maglaviceanu A, Wu B, Kapoor M. Fibroblast-like synoviocytes: Role in synovial fibrosis associated with osteoarthritis. Wound Repair Regen. 2021;29(4):642–649. https://doi.org/10.1111/wrr.12939.Maglaviceanu A, Wu B, Kapoor M. Fibroblast-like synoviocytes: Role in synovial fibrosis associated with osteoarthritis. Wound Repair Regen. 2021;29(4):642–649. https://doi.org/10.1111/wrr.12939.Oo WM, Little C, Duong V, Hunter DJ. The Development of Disease-Modifying Therapies for Osteoarthritis (DMOADs): The Evidence to Date. Drug Des Devel Ther. 2021;15:2921–2945. https://doi.org/10.2147/DDDT.S295224.Oo WM, Little C, Duong V, Hunter DJ. The Development of Disease-Modifying Therapies for Osteoarthritis (DMOADs): The Evidence to Date. Drug Des Devel Ther. 2021;15:2921–2945. https://doi.org/10.2147/DDDT.S295224.Dell’Isola A, Allan R, Smith SL, Marreiros SS, Steultjens M. Identification of clinical phenotypes in knee osteoarthritis: a systematic review of the literature. BMC Musculoskelet Disord. 2016;17(1):425. https://doi.org/10.1186/s12891-016-1286-2.Dell’Isola A, Allan R, Smith SL, Marreiros SS, Steultjens M. Identification of clinical phenotypes in knee osteoarthritis: a systematic review of the literature. BMC Musculoskelet Disord. 2016;17(1):425. https://doi.org/10.1186/s12891-016-1286-2.Dell’Isola A, Steultjens M. Classification of patients with knee osteoarthritis in clinical phenotypes: Data from the osteoarthritis initiative. PLoS ONE. 2018;13(1):e0191045. https://doi.org/10.1371/journal.pone.0191045.Dell’Isola A, Steultjens M. Classification of patients with knee osteoarthritis in clinical phenotypes: Data from the osteoarthritis initiative. PLoS ONE. 2018;13(1):e0191045. https://doi.org/10.1371/journal.pone.0191045.Caporali R, Cimmino MA, Sarzi-Puttini P, Scarpa R, Parazzini F, Zaninelli A et al. Comorbid conditions in the AMICA study patients: effects on the quality of life and drug prescriptions by general practitioners and specialists. Semin Arthritis Rheum. 2005;35(1 Suppl. 1):31–37. https://doi.org/10.1016/j.semarthrit.2005.02.004.Caporali R, Cimmino MA, Sarzi-Puttini P, Scarpa R, Parazzini F, Zaninelli A et al. Comorbid conditions in the AMICA study patients: effects on the quality of life and drug prescriptions by general practitioners and specialists. Semin Arthritis Rheum. 2005;35(1 Suppl. 1):31–37. https://doi.org/10.1016/j.semarthrit.2005.02.004.Alenazi AM, Alothman S, Alshehri MM, Rucker J, Waitman LR, Wick J et al. The prevalence of type 2 diabetes and associated risk factors with generalized osteoarthritis: a retrospective study using ICD codes for clinical data repository system. Clin Rheumatol. 2019;38(12):3539–3547. https://doi.org/10.1007/s10067-019-04712-0.Alenazi AM, Alothman S, Alshehri MM, Rucker J, Waitman LR, Wick J et al. The prevalence of type 2 diabetes and associated risk factors with generalized osteoarthritis: a retrospective study using ICD codes for clinical data repository system. Clin Rheumatol. 2019;38(12):3539–3547. https://doi.org/10.1007/s10067-019-04712-0.Стребкова ЕА, Алексеева ЛИ. Остеоартроз и ожирение. Научнопрактическая ревматология. 2015;53(5):542–552. Режим доступа: https://rsp.mediar-press.net/rsp/article/view/2131/1357.Strebkova EA, Alekseeva LI. Osteoarthritis and obesity. Rheumatology Science and Practice. 2015;53(5):542–552. (In Russ.) Available at: https://rsp.mediar-press.net/rsp/article/view/2131/1357.Zhang Q, Zhao YX, Li LF, Fan QQ, Huang BB, Du HZ et al. MetabolismRelated Adipokines and Metabolic Diseases: Their Role in Osteoarthritis. J Inflamm Res. 2025;18:1207–1233. https://doi.org/10.2147/JIR.S499835.Zhang Q, Zhao YX, Li LF, Fan QQ, Huang BB, Du HZ et al. MetabolismRelated Adipokines and Metabolic Diseases: Their Role in Osteoarthritis. J Inflamm Res. 2025;18:1207–1233. https://doi.org/10.2147/JIR.S499835.Sampath SJP, Venkatesan V, Ghosh S, Kotikalapudi N. Obesity, Metabolic Syndrome, and Osteoarthritis – An Updated Review. Curr Obes Rep. 2023;12(3):308–331. https://doi.org/10.1007/s13679-023-00520-5.Sampath SJP, Venkatesan V, Ghosh S, Kotikalapudi N. Obesity, Metabolic Syndrome, and Osteoarthritis – An Updated Review. Curr Obes Rep. 2023;12(3):308–331. https://doi.org/10.1007/s13679-023-00520-5.Fan J, Zhu J, Sun L, Li Y, Wang T, Li Y. Causal association of adipokines with osteoarthritis: a Mendelian randomization study. Rheumatology. 2021;60(6):2808–2815. https://doi.org/10.1093/rheumatology/keaa719.Fan J, Zhu J, Sun L, Li Y, Wang T, Li Y. Causal association of adipokines with osteoarthritis: a Mendelian randomization study. Rheumatology. 2021;60(6):2808–2815. https://doi.org/10.1093/rheumatology/keaa719.Yoshimura N, Muraki S, Oka H, Tanaka S, Kawaguchi H, Nakamura K, Akune T. Accumulation of metabolic risk factors such as overweight, hypertension, dyslipidaemia, and impaired glucose tolerance raises the risk of occurrence and progression of knee osteoarthritis: a 3-year follow-up of the ROAD study. Osteoarthritis Cartilage. 2012;20(11):1217–1226. https://doi.org/10.1016/j.joca.2012.06.006.Yoshimura N, Muraki S, Oka H, Tanaka S, Kawaguchi H, Nakamura K, Akune T. Accumulation of metabolic risk factors such as overweight, hypertension, dyslipidaemia, and impaired glucose tolerance raises the risk of occurrence and progression of knee osteoarthritis: a 3-year follow-up of the ROAD study. Osteoarthritis Cartilage. 2012;20(11):1217–1226. https://doi.org/10.1016/j.joca.2012.06.006.Berenbaum F. Diabetes-induced osteoarthritis: from a new paradigm to a new phenotype. Postgrad Med J. 2012;88(1038):240–242. https://doi.org/10.1136/pgmj.2010.146399rep.Berenbaum F. Diabetes-induced osteoarthritis: from a new paradigm to a new phenotype. Postgrad Med J. 2012;88(1038):240–242. https://doi.org/10.1136/pgmj.2010.146399rep.Ching K, Houard X, Berenbaum F, Wen C. Hypertension meets osteoarthritis – revisiting the vascular aetiology hypothesis. Nat Rev Rheumatol. 2021;17(9):533–549. https://doi.org/10.1038/s41584-021-00650-x.Ching K, Houard X, Berenbaum F, Wen C. Hypertension meets osteoarthritis – revisiting the vascular aetiology hypothesis. Nat Rev Rheumatol. 2021;17(9):533–549. https://doi.org/10.1038/s41584-021-00650-x.Xiong J, Long J, Chen X, Li Y, Song H. Dyslipidemia Might Be Associated with an Increased Risk of Osteoarthritis. Biomed Res Int. 2020;2020:3105248. https://doi.org/10.1155/2020/3105248.Xiong J, Long J, Chen X, Li Y, Song H. Dyslipidemia Might Be Associated with an Increased Risk of Osteoarthritis. Biomed Res Int. 2020;2020:3105248. https://doi.org/10.1155/2020/3105248.Каратеев АЕ, Насонов ЕЛ, Ивашкин ВТ, Мартынов АИ, Яхно НН, Арутюнов ГП и др. Рациональное использование нестероидных противовоспалительных препаратов. Клинические рекомендации. Научнопрактическая ревматология. 2018;56(Прил. 1):1–29. Режим доступа: https://rsp.mediar-press.net/rsp/article/view/2536.Karateev AE, Nasonov EL, Ivashkin VT, Martynov AI, Yakhno NN, Arutyunov GP et al. Rational use of nonsteroidal anti-inflammatory drugs. Clinical guidelines. Rheumatology Science and Practice. 2018;56(Suppl. 1):1–29. (In Russ.) Available at: https://rsp.mediar-press.net/rsp/article/view/2536.Алексеева ЛИ, Лила АМ. Базисная терапия остеоартрита: современный взгляд на применение препаратов глюкозамина и хондроитина. Современная ревматология. 2021;15(2):112–119. https://doi.org/10.14412/1996-7012-2021-2-112-119.Alekseeva LI, Lila AM. Osteoarthritis background therapy: current view on the glucosamine and chondroitin therapy. Sovremennaya Revmatologiya. 2021;15(2): 112–119. (In Russ.) https://doi.org/10.14412/1996-7012-2021-2-112-119.Лила АМ, Алексеева ЛИ, Бабаева АР, Гайдукова ИЗ, Гандолини Г, Зонова ЕВ и др. Возможности фармакологического лечения остеоартрита: фокус на симптоматические медленно действующие препараты (SYSADOA) и индивидуальные особенности пациента. Резолюция международного совещания экспертов. Современная ревматология. 2019;13(4):143–147. https://doi.org/10.14412/1996-7012-2019-4-143-147.Lila AM, Alekseeva LI, Babaeva AR, Gaydukova IZ, Gandolini G, Zonova EV et al. Pharmacological treatment options for osteoarthritis: focus on symptomatic slow-acting drugs for osteoarthritis (SYSADOA) and individual patient characteristics: Resolution of the International Expert Meeting. Sovremennaya Revmatologiya. 2019;13(4):143–147. (In Russ.) https://doi.org/10.14412/1996-7012-2019-4-143-147.Цурко ВВ, Замятина ЕА, Багирова ГГ. Остеоартрит: ведение пациентов и приверженность к лечению. Медицинский совет. 2017;(20):134–137. https://doi.org/10.21518/2079-701X-2017-20-134-137.Tsurko VV, Zamyatina EA, Bagrova GG. Osteoarthritis: management of patients and compliaence to treatment Meditsinskiy Sovet. 2017;(20):134–137. (In Russ.) https://doi.org/10.21518/2079-701X-2017-20-134-137.Феклистов АЮ, Воробьева ЛД, Алексеева ОГ, Сухинина АВ, Андрианова ИА, Меньшикова ИВ и др. Post hoc анализ результатов сравнительного наблюдательного клинического исследования КОЛИБРИ у пациентов с остеоартритом коленных суставов и мелких суставов кистей. Современная ревматология. 2022;16(6):64–72. https://doi.org/10.14412/1996-7012-2022-6-64-72.Feklistov AYu, Vorobieva LD, Alekseeva OG, Sukhinina AV, Andrianova IA, Menshikova IV et al. Post hoc analysis of the results of KOLIBRI comparative observational clinical study in patients with knee and small hand joints osteoarthritis. Sovremennaya Revmatologiya. 2022;16(6):64–72. (In Russ.) https://doi.org/10.14412/1996-7012-2022-6-64-72.Данилов АБ, Лила АМ, Феклистов АЮ. Два взгляда на проблему остеоартрита и остеохондроза: сравнение подходов к терапии (пострелиз). РМЖ. 2021;29(7):74–78. Режим доступа: https://www.rmj.ru/articles/revmatologiya/Dva_vzglyada_naproblemu_osteoartrita_iosteohondroza_sravnenie_podhodov_kterapii_postreliz/.Danilov AB, Lila AM, Feklistov AYu. Two views on the problem of osteoarthritis and osteochondrosis: comparison of approaches to the therapy (post-release). RMJ. 2021;29(7):74–78. (In Russ.) Available at: https://www.rmj.ru/articles/revmatologiya/Dva_vzglyada_naproblemu_osteoartrita_iosteohondroza_sravnenie_podhodov_kterapii_postreliz/Кцоева АА, Тотров ИН, Теблоев ММ, Купеева АМ, Кусова АБ, Албегова ЗА и др. Хрящевой гликопротеин-39 – лабораторный маркер динамики течения и эффективности лечения у пациентов с остеоартритом. Медицинский алфавит. 2023;(9):57–63. https://doi.org/10.33667/20785631-2023-9-57-63.Ktsoyeva AA, Totrov IN, Tebloev MM, Kupeeva AM, Kusova AB, Albegova ZA et al. Cartilaginous glycoprotein-39 as laboratory marker of dynamics of course and effectiveness of treatment in patients with osteoarthritis. Medical Alphabet. 2023;(9):57–63. (In Russ.) https://doi.org/10.33667/2078-5631-2023-9-57-63.Ханов АГ. Опыт применения современного хондропротектора у пациентов с первичным и вторичным остеоартритом различной локализации в стадии обострения. Лечащий врач. 2023;26(5):29–35. https://doi.org/10.51793/OS.2023.26.5.005.Khanov AG. Experience in the use of a modern chondroprotector in patients with primary and secondary osteoarthritis of various localization in the acute stage. Lechaschi Vrach. 2023;26(5):29–35. (In Russ.) https://doi.org/10.51793/OS.2023.26.5.005.

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