Иммунопатология ревматической полимиалгии: связь с клинической картиной и перспективы таргетной терапии

Ревматическая полимиалгия является одним из наиболее распространенных воспалительных ревматических заболеваний у лиц пожилого возраста. Целью настоящего обзора стал анализ современных представлений об иммунопатогенезе ревматической полимиалгии и возможностях патогенетической терапии заболевания. Поиск литературы проводился в базах данных PubMed, Scopus, Web of Science, eLIBRARY.RU и Google Scholar по ключевым словам: polymyalgiarheumatica, immunopathogenesis, immunosenescence, methotrexate, biologictherapy, IL-6 inhibitors, IL-17 inhibitors, targetedtherapy, tocilizumab, sarilumab, olokizumab, tofacitinib, baricitinib и их русскоязычным аналогам. Первично было выявлено 110 публикаций. После полнотекстового анализа 24 статьи были исключены в связи с несоответствием тематике обзора, недостаточной информативностью либо отсутствием значимых данных по иммунопатогенезу и терапии ревматической полимиалгии. В качественный анализ включены 86 работ, в т. ч. рандомизированные контролируемые исследования, когортные исследования, клинические наблюдения, систематические обзоры и фундаментальные исследования. Для подготовки раздела «Введение» использовались 12 публикаций, посвященных иммунопатологии ревматической полимиалгии. Проведенный анализ показал, что ключевую роль в патогенезе ревматической полимиалгии играют процессы иммуностарения, активация врожденного и адаптивного иммунитета, нарушения Ти В-клеточного иммунного ответа и дисрегуляция цитокиновой сети с ведущим значением интерлейкина-6. Наиболее убедительная доказательная база в настоящее время накоплена для ингибиторов интерлейкина-6 и интерлейкина-17, эффективность которых подтверждена результатами рандомизированных клинических исследований. Расширение знаний о механизмах заболевания способствует развитию персонализированных подходов к лечению пациентов с ревматической полимиалгией и оптимизации долгосрочного контроля заболевания.

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