Скелетно-мышечные проявления постковидного синдрома: обзор литературы

Вспышка новой коронавирусной инфекции в городе Ухань в 2019 г. привела к пандемии, которая не только повлекла за собой глобальные социальные изменения, но и стала вызовом для всего медицинского сообщества. В процессе накопления материала по данному заболеванию была выявлена мультисистемность поражения внутренних органов с развитием новых ассоциированных состояний, в частности связанных с иммунопатологией и ревматологическими заболеваниями. В данном обзоре приведены литературные данные о симптомах поражения опорно-двигательного аппарата в различные периоды новой коронавирусной инфекции (COVID-19). В статье дано определение понятиям «постковидный синдром» и Long COVID, описаны клинические наблюдения и наиболее типичные симптомы у взрослых и детей. Описаны клинические случаи возникновения суставного синдрома у пациентов, перенесших новую коронавирусную инфекцию и не имевших ревматологических заболеваний в анамнезе. Также рассмотрен возможный молекулярный патогенез активации аутоиммунитета (клеточный и гуморальный иммунный ответ, а также прямое цитотоксическое действие вируса) как в остром периоде коронавирусной инфекции, так и в период реконвалесценции. Проведен анализ литературных данных об особенностях течения COVID-19 у пациентов с заболеваниями ревматологического профиля, в частности риск заражения, тяжелого течения и неблагоприятного исхода. В целом по результатам анализа литературных данных поражение опорно-двигательного аппарата чаще встречается в период от 3 до 10 нед. после завершения острой стадии инфекции, чаще всего проявляясь болями в мышцах и суставах, в то же время частота развития истинных реактивных артритов, ассоциированных с COVID-19, невысока. Патогенез поражения опорно-двигательного аппарата требует дальнейшего исследования, а пациенты – наблюдения в течение более длительного времени.

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