Медицинский совет (Dec 2020)
Management tactics for patients with osteoarthritis: a joint view of a rheumatologist and an orthopedic traumatologist
Abstract
Osteoarthritis is a common disease and occupies the leading place in the number of cases of disability in the world. The pathogenesis of this topical nosology is actively condemned, and researchers have offered a lot of evidence for the leading role of inflammation in the pathogenesis of osteoarthritis, which, by stimulating internal catabolic reactions of chondrocytes, leads to inflammation of the synovial membrane and, as a result, the occurrence of joint pain. Osteoarthritis is the disease with the highest incidence of comorbidities, which complicates the choice of medications for its treatment. And, despite the variety of recommendations, the issue of treating patients with OA remains complex. Based on the recommendations of ESCEO, which were updated in 2019, it is necessary to follow a step-by-step tactic, according to which the introduction of hyaluronic acid preparations intra-articularly is recommended at the 2nd stage of therapy as part of advanced pharmacological correction. Intra-articular hyaluronic acid injection is an alternative local treatment option that provides symptomatic benefit without systemic adverse events. The clinical example demonstrates the experience of joint decision-making on the tactics of managing a patient with persistent OA and the ineffectiveness of therapy at the previous stages. Preference was given to the preparation with high-molecular hyaluronic acid, in the production of which no cross-linking agents were used, due to its effectiveness and safety. A good analgesic and symptom modifying effect of the drug was demonstrated with the result remaining for 6 months. The authors believe that in patients with high comorbidity, drugs for intra-articular administration of hyaluronic acid can take a worthy place in the treatment of osteoarthritis.
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