mrjСовременная ревматологияModern Rheumatology Journal1996-70122310-158XIMA-PRESS, LLC10.14412/1996-7012-2024-5-81-89mrj-1643Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSКлинико-инструментальная характеристика остеоартрита при гиперурикемииClinical and instrumental characteristics of osteoarthritis in hyperuricemiahttps://orcid.org/0000-0001-8218-3223ТаскинаЕ. А.TaskinaE. A.

Елена Александровна Таскина

115522, Москва, Каширское шоссе, 34А

Elena Aleksandrovna Taskina

34A, Kashirskoe Shosse, Moscow 115522

braell@mail.ruhttps://orcid.org/0000-0002-6068-3080ЛилаА. М.LilaA. M.

115522, Москва, Каширское шоссе, 34А; 125993, Москва, ул. Баррикадная, 2/1, стр. 1

34A, Kashirskoe Shosse, Moscow 115522; 2/1, Barrikadnaya Street, Build. 1, Moscow 125993

https://orcid.org/0000-0001-7017-0898АлексееваЛ. И.AlekseevaL. I.

115522, Москва, Каширское шоссе, 34А; 125993, Москва, ул. Баррикадная, 2/1, стр. 1

34A, Kashirskoe Shosse, Moscow 115522; 2/1, Barrikadnaya Street, Build. 1, Moscow 125993

https://orcid.org/0000-0001-8732-2720КашевароваН. Г.KashevarovaN. G.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

https://orcid.org/0009-0000-1481-7749МихайловК. М.MikhailovK. M.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

https://orcid.org/0000-0002-0447-4110ХальметоваА. Р.HalmetovaA. R.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

https://orcid.org/0000-0001-8130-5081СтребковаЕ. А.StrebkovaE. A.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

https://orcid.org/0000-0003-4242-8278ШараповаЕ. П.SharapovaE. P.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

https://orcid.org/0000-0001-8562-6077СавушкинаН. М.SavushkinaN. M.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

КудинскийД. М.KudinskiyD. M.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

https://orcid.org/0000-0002-5804-4298РаскинаТ. А.RaskinaT. A.

650056, Кемерово, ул. Ворошилова, 22

22A, Voroshilova Street, Kemerovo 650056

https://orcid.org/0000-0001-5052-912XВиноградоваИ. Б.VinogradovaI. B.

432017, Ульяновск, ул. Третьего Интернационала, 7

7, III Internatzionala Street, Ulyanovsk 432017

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian FederationФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»; кафедра ревматологии ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияV.A. Nasonova Research Institute of Rheumatology; Department of Rheumatology Russian Medical Academy of Continuing Professional EducationRussian FederationФГБОУ ВО «Кемеровский государственный медицинский университет» Минздрава РоссииРоссияKemerovo State Medical UniversityRussian FederationГУЗ «Ульяновская областная клиническая больница»РоссияUlyanovsk Regional Clinical HospitalRussian Federation2024201020241858189Copyright © Таскина Е.А., Лила А.М., Алексеева Л.И., Кашеварова Н.Г., Михайлов К.М., Хальметова А.Р., Стребкова Е.А., Шарапова Е.П., Савушкина Н.М., Кудинский Д.М., Раскина Т.А., Виноградова И.Б., 20242024Таскина Е.А., Лила А.М., Алексеева Л.И., Кашеварова Н.Г., Михайлов К.М., Хальметова А.Р., Стребкова Е.А., Шарапова Е.П., Савушкина Н.М., Кудинский Д.М., Раскина Т.А., Виноградова И.Б.Taskina E.A., Lila A.M., Alekseeva L.I., Kashevarova N.G., Mikhailov K.M., Halmetova A.R., Strebkova E.A., Sharapova E.P., Savushkina N.M., Kudinskiy D.M., Raskina T.A., Vinogradova I.B.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/1643

Цель многоцентрового одномоментного исследования – оценить взаимосвязь гиперурикемии (ГУ) с клинико-инструментальными и лабораторными параметрами при остеоартрите (ОА).

Материал и методы

Материал и методы. В исследование включено 200 пациентов 40–75 лет с достоверным диагнозом ОА коленных суставов (КС), соответствующим критериям ACR, с I–III стадией ОА по Kellgren–Lawrence. Средний возраст пациентов составил 55,9±10,3 года, индекс массы тела (ИМТ) – 29,4±6,2 кг/м2. На каждого больного заполнялась индивидуальная карта, включавшая антропометрические показатели, данные анамнеза и клинического осмотра, оценку боли в КС по визуальной аналоговой шкале (ВАШ), WOMAC, общего состояния здоровья пациента (ОСЗП) и сведения о сопутствующих заболеваниях. Всем больным проводились стандартная рентгенография и магнитно-резонансная томография (МРТ) КС (WORMS), денситометрия поясничного отдела позвоночника и шейки бедренной кости, лабораторное обследование.

Результаты и обсуждение

Результаты и обсуждение. ГУ, которую диагностировали при уровне мочевой кислоты (МК) в сыворотке крови >360 мкмоль/л, выявлена у 57 (28,5%) больных. В зависимости от наличия или отсутствия ГУ пациенты были распределены в две группы. Пациенты двух групп были сопоставимы по возрасту, но значимо различались по длительности заболевания, ИМТ, объему талии и бедер, которые были больше в группе ГУ (p<0,05). Статистически значимые различия выявлены и при оценке тяжести течения ОА: при ГУ отмечались более высокие показатели боли по ВАШ, суммарного счета WOMAC и его составляющих (боли и функциональной недостаточности, ФН), ОСЗП. При МРТ более часто имелся остеит в медиальных отделах большеберцовой кости – ББК (отношение шансов 5,75; 95% доверительный интервал 1,29–25,6; р=0,03). У пациентов с ГУ регистрировалась более высокая концентрация СРБ, СOMP, лептина, инсулина, триглицеридов, креатинина (р<0,05 для всех значений).

Анализ корреляций по Спирмену подтвердил взаимосвязь ГУ с длительностью и рентгенологической стадией ОА, наличием остеита в медиальном отделе ББК, выявляемого при МРТ, болью по ВАШ и WOMAC, ФН по WOMAC, ОСЗП (p<0,05).

Заключение

Заключение. При высоком уровне МК отмечаются большие значения боли по ВАШ, WOMAC, худшие показатели ОСЗП, повышение уровня СРБ и СOMP. При МРТ у лиц с ГУ чаще выявляется остеит в медиальном отделе ББК. Расшифровка механизмов, определяющих взаимосвязь ГУ и ОА, имеет важное значение для разработки новых методов профилактики и лечения этих заболеваний.

Objective

Objective: to investigate in a multicentre single-stage study the relationships between hyperuricemia (HU) and clinical, instrumental and laboratory parameters of osteoarthritis (OA).

Material and methods

Material and methods. The study included 200 patients aged 40 to 75 years with a definite diagnosis of knee (KN) OA that met ACR criteria, with stage I–III OA by Kellgren–Lawrence. The mean age of the patients was 55.9±10.3 years and the body mass index (BMI) was 29.4±6.2 kg/m2. An individual chart was completed for each patient, including anthropometric parameters, medical history and clinical examination data, visual analogue scale (VAS) assessment of KN pain, WOMAC, patient's general health assessment (GHA) and information on comorbidities. All patients underwent standard radiography and magnetic resonance imaging (MRI) of the KN (WORMS), dual-energy X-ray absorptiometry of the lumbar spine and femoral neck, and laboratory examination.

Results and discussion

Results and discussion. HU was diagnosed in 57 (28.5) patients when the serum uric acid (UA) level was above 360 μmol/L. Patients were divided into two groups according to the presence or absence of HU. The age of the patients in the two groups was comparable, but they differed significantly in terms of disease duration, BMI, waist and hip circumference, which were greater in the HU group (p <0.05). Statistically significant differences were also found in the assessment of the severity of OA course: there were higher pain indices according to VAS, WOMAC total score and its components (pain and functional impairment, FI), GHA in the HU group. On MRI, osteitis was more common in the medial aspect of the tibia (odds ratio 5.75; 95% confidence interval 1.29–25.6; p=0.03). Patients with HU had higher concentrations of CRP, COMP, leptin, insulin, triglycerides and creatinine (p <0.05 for all values).

Spearman correlation analysis confirmed the association between HU and duration and radiological stage of OA, the presence of osteitis in the medial aspect of tibia detected by MRI, pain according to VAS and WOMAC, FI according to WOMAC and GHA (p<0.05).

Conclusion

Conclusion. At high UA levels, pain values according to VAS and WOMAC are higher, GHA is worse, and CRP and COMP levels are elevated. MRI shows more frequent osteitis in the medial aspect of the tibia in patients with HU. Deciphering the mechanisms that determine the relationship between HU and OA is important for the development of new methods for the prevention and treatment of these diseases.

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The authors declare that there are no conflicts of interest present.