Влияние снижения веса и физических упражнений на боль в суставах у пациентов с остеоартритом и ожирением

Остеоартрит (ОА), наиболее часто встречающееся заболевание суставов, у большей части населения планеты сосуществует с ожирением. По прогнозу Всемирной организации здравоохранения, ожидается увеличение числа больных с этими заболеваниями, что представляет серьезную медицинскую и социальную проблему из-за увеличения инвалидизации, потребности в хирургическом лечении, роста коморбидных заболеваний, осложнений терапии и смертности у этой группы пациентов. ОА и ожирение имеют общие патогенетические механизмы, и развитие одного заболевания увеличивает риск развития другого, может стать началом порочного круга. В последние годы ожирение рассматривается не только как биомеханический фактор (избыточная нагрузка на сустав, разрушение суставного хряща), но и как причина возникновения метаболического синдрома, системных воспалительных эффектов. Воспалительные цитокины, особенно IL-1β и TNF-α, управляют катаболическими путями и способствуют прогрессированию ОА. Получены убедительные доказательства того, что снижение массы тела уменьшает боль и воспаление в суставах, улучшает прогноз у пациентов с ОА. В обзоре представлены данные о распространенности ОА и ожирения, роли иммунных нарушений при этих заболеваниях, указаны методы фармакологического и нефармакологического лечения ОА. Изложены общие принципы и конкретные обновленные рекомендации Европейской антиревматической лиги по немедикаментозному лечению ОА тазобедренного и коленного суставов, сформулированы рекомендации по снижению веса с помощью диетических вмешательств и физических упражнений.

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