mrjСовременная ревматологияModern Rheumatology Journal1996-70122310-158XIMA-PRESS, LLC10.14412/1996-7012-2024-3-58-62mrj-1589Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSЭффективность низкомолекулярной гиалуроновой кислоты (500–730 кДа) при посттравматической патологии околосуставных мягких тканей различной локализации: данные открытого пилотного клинического исследованияEfficacy of low molecular weight hyaluronic acid (500–730 kDa) in post-traumatic pathology of periarticular soft tissues at different sites: data from an open-label pilot clinical studyhttps://orcid.org/0000-0002-7179-8174НестеренкоВ. А.NesterenkoV. A.

Вадим Андреевич Нестеренко

115522; Каширское шоссе, 34А; Москва

Vadim Andreevich Nesterenko

115522; 34A, Kashirskoe Shosse; Moscow

Swimguy91@mail.ruhttps://orcid.org/0000-0002-5626-7404МакаровМ. А.MakarovM. A.

115522; Каширское шоссе, 34А; Москва

115522; 34A, Kashirskoe Shosse; Moscow

https://orcid.org/0000-0002-1391-0711КаратеевА. Е.KarateevA. E.

115522; Каширское шоссе, 34А; Москва

115522; 34A, Kashirskoe Shosse; Moscow

https://orcid.org/0000-0001-7938-1536БяликЕ. И.BialikE. I.

115522; Каширское шоссе, 34А; Москва

115522; 34A, Kashirskoe Shosse; Moscow

https://orcid.org/0000-0002-3745-0924БяликВ. Е.BialikV. E.

115522; Каширское шоссе, 34А; Москва

115522; 34A, Kashirskoe Shosse; Moscow

https://orcid.org/0000-0002-5256-7346БяликА. А.BialikA. A.

115522; Каширское шоссе, 34А; Москва

115522; 34A, Kashirskoe Shosse; Moscow

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation2024140620241835862Copyright © Нестеренко В.А., Макаров М.А., Каратеев А.Е., Бялик Е.И., Бялик В.Е., Бялик А.А., 20242024Нестеренко В.А., Макаров М.А., Каратеев А.Е., Бялик Е.И., Бялик В.Е., Бялик А.А.Nesterenko V.A., Makarov M.A., Karateev A.E., Bialik E.I., Bialik V.E., Bialik A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://mrj.ima-press.net/mrj/article/view/1589

   Локальная инъекционная терапия (ЛИТ) с применением препаратов гиалуроновой кислоты (ГлК) – один из перспективных методов лечения патологии околосуставных мягких тканей (ПОМТ), вызванной травмой или избыточной нагрузкой.

   Цель исследования – оценить эффективность и безопасность ЛИТ препаратом ГлК с молекулярной массой 500–730 кДа у пациентов с различной посттравматической ПОМТ.

   Материал и методы

   Материал и методы. В исследовании участвовало 30 пациентов с синдромом сдавления ротатора плеча (ССРП), латеральным эпикондилитом (ЛЭ) и плантарным фасциитом (ПФ), возникшими после травмы. Критерием включения было наличие умеренной/выраженной боли (≥ 40 мм по визуальной аналоговой шкале, ВАШ) на протяжении 3 мес и отсутствие эффекта от ЛИТ глюкокортикоидами. Всем больным проводилось трехкратное (с интервалом в 7 дней) околосухожильное введение ГлК под контролем УЗИ. Результаты лечения оценивали через 1 и 3 мес по динамике интенсивности боли (по ВАШ) и функциональным показателям с помощью опросников ASES (Американская хирургическая оценка плеча и локтя), MES (индекс локтя Мэйо), FFI (функциональный индекс стопы).

   Результаты и обсуждение. В общей группе отмечалось статистически значимое снижение интенсивности боли через 1 и 3 мес в среднем с 57,6 ± 14,7 до 37,0 ± 14,8 и 35,0 ± 14,3 мм по ВАШ соответственно (p < 0,05). В группах пациентов с различной ПОМТ оценка интенсивности боли и функциональных нарушений исходно и через 1 и 3 мес в среднем составила: при ССРП (n = 11) 59,0 ± 15,1, 39,0 ± 15,7, 36,3 ± 16,2 мм по ВАШ и 49,1 ± 14,3, 60,1 ± 13,7, 61,7 ± 13,8 по ASES соответственно; при ЛЭ (n = 10) 54,0 ± 13,4, 35,0 ± 9,7, 34,0 ± 11,7 мм по ВАШ и 71,5 ± 11,1, 78,3 ± 9,0, 81,5 ± 8,3 по MES; при ПФ (n = 9) 61,0 ± 16,5, 36,6 ± 19,3, 34,4 ± 15,8 мм по ВАШ и 47,2 ± 22,8, 39,6 ± 39,7, 39,0 ± 29,9 по FFI. Ни у кого из больных на фоне терапии не отмечалось развития неблагоприятных реакций.

   Заключение

   Заключение. Препарат ГлК с молекулярной массой 500–730 кДа показал хорошую эффективность и безопасность при ЛИТ ПОМТ плечевого, локтевого суставов и стопы. Требуются дальнейшие исследования для оценки возможности его широкого использования для лечения ПОМТ в реальной клинической практике.

   Local injection therapy (LIT) with hyaluronic acid (HA) medications is one of the most promising methods for the treatment of periarticular soft tissue pathology (PASTP) caused by injury or overuse.

   Objective

   Objective: to evaluate the efficacy and safety of LIT with HA medication with a molecular weight of 500–730 kDa in patients with various post-traumatic PASTP.

   Material and methods

   Material and methods. The study included 30 patients with rotator cuff syndrome (RCS), lateral epicondylitis (LE) and plantar fasciitis (PF) after trauma. Inclusion criteria were the presence of moderate/severe pain (≥40 mm on a visual analogue scale (VAS)) over a 3-month period and the absence of effect of LIT with glucocorticoids. All patients were administered HA peritendinously three times (7 days apart) under ultrasound guidance. Treatment results were evaluated after 1 and 3 months based on the dynamics of pain intensity (VAS) and functional indicators using the ASES (American Shoulder and Elbow Surgical Evaluation), MES (Mayo Elbow Score) and FFI (Foot Functional Index) questionnaires.

   Results and discussion. In the general group, there was a statistically significant decrease in pain intensity after 1 and 3 months from a mean of 57.6 ± 14.7 to 37.0 ± 14.8 and 35.0 ± 14.3 mm according to VAS respectively (p < 0.05). In the patient groups with different PASTP, the average assessment of pain intensity and functional impairment at baseline and after 1 and 3 months was: for RCS (n = 11) 59.0 ± 15.1, 39.0 ± 15.7, 36.3 ± 16.2 mm according to VAS and 49.1 ± 14.3, 60.1 ± 13.7, 61.7 ± 3.8 according to ASES, respectively; with LE (n = 10) 54.0 ± 13.4, 35.0 ± 9.7, 34.0 ± 11.7 mm according to VAS and 71.5 ± 11.1, 78.3 ± 9.0, 81.5 ± 8.3 according to MES; with PF (n = 9) 61.0 ± 16.5, 36.6 ± 19.3, 34.4 ± 15.8 mm according to VAS and 47.2 ± 22.8, 39.6 ± 39.7, 39.0 ± 29.9 according to FFI. None of the patients experienced any adverse events during treatment.

   Conclusion

   Conclusion. HA medication with a molecular weight of 500–730 kDa showed good efficacy and safety in LIT of PASTP of the shoulder, elbow joint and foot. Further studies are needed to evaluate the possibility of a broad use of the drug for the treatment of PASTP in real clinical practice.

патология околосуставных мягких тканейсиндром сдавления ротатора плечалатеральный эпикондилитплантарный фасциитлокальные инъекциигиалуроновая кислотаperiarticular soft tissue pathologyrotator cuff syndromelateral epicondylitisplantar fasciitislocal injectionshyaluronic acidСтатья подготовлена в рамках научно-исследовательской работы FURS – 2022-009 1021062512064-0 (№ государственного задания 1021062512064-0)The article was prepared as part of the research work FURS – 2022-009 1021062512064-0, state assignment №1021062512064-0. The investigation has not been sponsoredReferencesКаратеев АЕ, Лила АМ, Загородний НВ, Погожева ЕЮ. Поражение околосуставных мягких тканей в реальной клинической практике: частота, характер, эффективность нестероидных противовоспалительных препаратов. Терапевтический архив. 2019;91(12):21-28.Karateev AE, Lila AM, Zagorodny NV, Pogozheva EYu. 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The authors declare that there are no conflicts of interest present.