mrj

Современная ревматология

Modern Rheumatology Journal

1996-70122310-158X

IMA-PRESS, LLC

10.14412/1996-7012-2015-1-4-23

mrj-590

Research Article

КЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИ

CLINICAL GUIDELINES

КЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИ «Рациональное применение нестероидных противовоспалительных препаратов (НПВП) в клинической практике»

Clinical guidelines «Rational use of nonsteroidal anti-inflammatory drugs (NSAIDs) in clinical practice»

Каратеев

А. Е.

Karateev

A. E.

д.м.н., заведующий лабораторией гастроэнтерологических проблем у пациентов с ревматическими заболеваниями,

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115552

aekarateev@rambler.ru

Насонов

Е. Л.

Nasonov

E. L.

академик РАН, д.м.н., профессор, директор,

115522, Москва, Каширское шоссе, 34А;

президент

34A, Kashirskoe Shosse, Moscow 115552

Яхно

Н. Н.

Yakhno

N. N.

академик РАМН, д.м.н., профессор, заведующий научно-исследовательским отделом неврологии НИЦ, профессор кафедры нервных болезней и нейрохирургии лечебного факультета, директор Научно-образовательного клинического центра неврологии,

119991, Москва, ул. Трубецкая, 8, стр. 2;

президент,

Москва, Россия

8, Trubetskaya St., Build. 2, Moscow 119991

Ивашкин

В. Т.

Ivashkin

V. T.

академик РАН, д.м.н., профессор, заведующий кафедрой пропедевтики внутренних болезней, директор Клиники пропедевтики внутренних болезней, гастроэнтерологии и гепатологии им. В.Х. Василенко,

119991, Москва, ул. Трубецкая, 8, стр. 2;

президент,

Москва, Россия

8, Trubetskaya St., Build. 2, Moscow 119991

Чичасова

Н. В.

Chichasova

N. V.

д.м.н., профессор кафедры ревматологии,

119991, Москва, ул. Трубецкая, 8, стр. 2

8, Trubetskaya St., Build. 2, Moscow 119991

Алексеева

Л. И.

Alekseeva

L. I.

д.м.н., руководитель отдела метаболических заболеваний костей и суставов c центром профилактики остеопороза Минздрава России,

115522, Москва, Каширское шоссе,

34A, Kashirskoe Shosse, Moscow 115552

Карпов

Ю. А.

Karpov

Yu. A.

д.м.н., профессор, первый заместитель гене- рального директора, заместитель генерального директора по науке,

121552, Москва, ул. 3-я Черепковская, 15А;

вице-президент,

Москва, Россия

15A, Third Cherepkovskaya St., Moscow 121552

Евсеев

М. А.

Evseev

M. A.

д.м.н., профессор, заведующий 2-м хирургическим отделением,

123182, Москва, ул. Пехотная, 3

3, Pekhotnaya St., Moscow 123182

Кукушкин

М. Л.

Kukushkin

M. L.

д.м.н., профессор, руководитель лаборато- рии фундаментальных и прикладных проблем боли,

125315, Москва, ул. Балтийская, 8;

ответственный секретарь,

Москва, Россия

8, Baltiyskaya St., Moscow 125315

Данилов

А. Б.

Danilov

A. B.

д.м.н., профессор кафедры нервных болезней,

119991, Москва, ул. Трубецкая, 8, стр. 2

8, Trubetskaya St., Build. 2, Moscow 119991

Воробьева

О. В.

Vorobyeva

O. V.

д.м.н. профессор кафедры нервных болезней,

119991, Москва, ул. Трубецкая, 8, стр. 2

8, Trubetskaya St., Build. 2, Moscow 119991

Амелин

А. В.

Amelin

A. V.

д.м.н., профессор кафедры неврологии и нейро- хирургии с клиникой,

197022, Санкт-Петербург, ул. Льва Толстого, 6/8

заведующий лабораторией нейрофизиологии и фармакологии боли,

Санкт-Петербург, Россия

6/8, Lev Tolstoy St., Saint Petersburg 197022

Новикова

Д. С.

Novikova

D. S.

д.м.н., ведущий научный сотрудник лаборатории инструментальной и ультразвуковой диагностики,

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115552

Драпкина

О. М.

Drapkina

O. M.

д.м.н., профессор кафедры пропедевтики внутренних болезней,

119991, Москва, ул. Трубецкая, 8, стр. 2

8, Trubetskaya St., Build. 2, Moscow 119991

Копенкин

С. С.

Kopenkin

S. S.

к.м.н., доцент кафедры травматологии, ортопедии и военно-полевой хирургии,

117997, Москва, ул. Островитянова, 1

1, Ostrovityanov St., Moscow 117997

Абузарова

Г. Р.

Abuzarova

G. R.

д.м.н., руководитель Центра,

125284, Москва, 2-й Боткинский проезд, 3

3, Second Botkinsky Proezd, Moscow 125284

ФГБНУ НИИР им. В.А. НасоновойРоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation

ФГБНУ НИИР им. В.А. Насоновой; Ассоциация ревматологов РоссииРоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation

ГБОУ ВПО «Первый МГМУ им. И.М. Сеченова» Минздрава России; Российское общество по изучению болиРоссияI.M. Sechenov First Moscow State Medical University, Ministry of Health of RussiaRussian Federation

ГБОУ ВПО «Первый МГМУ им. И.М. Сеченова» Минздрава России; Российская гастроэнтерологическая ассоциацияРоссияI.M. Sechenov First Moscow State Medical University, Ministry of Health of RussiaRussian Federation

ИПО ГБОУ ВПО «Первый МГМУ им. И.М. Сеченова» Минздрава РоссииРоссияI.M. Sechenov First Moscow State Medical University, Ministry of Health of RussiaRussian Federation

ФГБНУ «Российский кардиологический научно-производственный комплекс» Минздрава России; Российское кардиологическое обществоРоссияRussian Cardiology Research-and-Production Complex, Ministry of Health of RussiaRussian Federation

ГБУ «Городская клиническая больница №52» ДЗ МосквыРоссияCity Clinical Hospital Fifty-Two, Moscow Healthcare DepartmentRussian Federation

ФГБНУ «НИИ общей патологии и патофизиологии»; Российское общество по изучению болиРоссияResearch Institute of General Pathology and PathophysiologyRussian Federation

ГБОУ ВПО «Санкт-Петербургский государственный медицинский университет им. И.П. Павлова» Минздрава России; Институт фармакологии им. А.В. ВальдманаРоссияI.P. Pavlov Saint Petersburg State Medical University, Ministry of Health of RussiaRussian Federation

ГБОУ ВПО «Первый МГМУ им. И.М. Сеченова» Минздрава РоссииРоссияI.M. Sechenov First Moscow State Medical University, Ministry of Health of RussiaRussian Federation

ГБОУ ВПО «РНИМУ им. Н.И. Пирогова» Минздрава РоссииРоссияN.I. Pirogov Russian National Research Medical University, Ministry of Health of RussiaRussian Federation

Центр паллиативной помощи онкологическим больным при ФГБНУ «МНИОИ им. П.А. Герцена» Минздрава РоссииРоссияP.A. Herzen Moscow Oncology Research Institute, Branch, Ministry of Health of RussiaRussian Federation

2015

22032015

91423

Copyright © Каратеев А.Е., Насонов Е.Л., Яхно Н.Н., Ивашкин В.Т., Чичасова Н.В., Алексеева Л.И., Карпов Ю.А., Евсеев М.А., Кукушкин М.Л., Данилов А.Б., Воробьева О.В., Амелин А.В., Новикова Д.С., Драпкина О.М., Копенкин С.С., Абузарова Г.Р., 2015

2015

Каратеев А.Е., Насонов Е.Л., Яхно Н.Н., Ивашкин В.Т., Чичасова Н.В., Алексеева Л.И., Карпов Ю.А., Евсеев М.А., Кукушкин М.Л., Данилов А.Б., Воробьева О.В., Амелин А.В., Новикова Д.С., Драпкина О.М., Копенкин С.С., Абузарова Г.Р.

Karateev A.E., Nasonov E.L., Yakhno N.N., Ivashkin V.T., Chichasova N.V., Alekseeva L.I., Karpov Y.A., Evseev M.A., Kukushkin M.L., Danilov A.B., Vorobyeva O.V., Amelin A.V., Novikova D.S., Drapkina O.M., Kopenkin S.S., Abuzarova G.R.

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/590

Представлена новая редакция клинических рекомендаций «Рациональное применение нестероидных противовоспалительных препаратов (НПВП) в клинической практике», подготовленных Ассоциацией ревматологов России, Российским обществом по изучению боли, Российской гастроэнтерологической ассоциацией, Российским кардиологическим обществом, Ассоциацией травматологов-ортопедов России, Ассоциацией междисциплинарной медицины, Российской ассоциацией паллиативной медицины. В нашей стране НПВП являются важнейшим и наиболее популярным классом анальгетиков. В отличие от мировой практики российские врачи достаточно редко рекомендуют парацетамол как препарат «первой линии» для купирования умеренной или сильной боли, отдавая предпочтение НПВП; использование опиоидных анальгетиков при неонкологических заболеваниях сведено к минимуму из-за жестких ограничений.

НПВП эффективны и удобны в использовании, однако они далеко не безопасны – прием этих препаратов в ряде случаев может приводить к развитию серьезных осложнений со стороны желудочно-кишечного тракта, сердечно-сосудистой системы, почек и др. Поэтому применение НПВП должно включать обязательный контроль нежелательных реакций, а выбор конкретного препарата для каждого клинического случая должен основываться на объективной оценке соотношения его эффективности и безопасности. В последние годы опубликованы свежие данные об использовании НПВП при различных заболеваниях, а на российском фармакологическом рынке появилось несколько новых представителей этой лекарственной группы.

Все это определило необходимость создания новой редакции рекомендаций по рациональному использованию НПВП. Они основаны на положениях, имеющих высокий уровень доказательности и подтвержденных результатами хорошо организованных клинических и масштабных популяционных исследований, а также их метаанализом. Рекомендации предназначены для врачей всех специальностей.

The paper presents the new version of the clinical guidelines «Rational use of nonsteroidal anti-inflammatory drugs (NSAIDs) in clinical practice » prepared by the Association of Rheumatologists of Russia, the Russian Pain Society, the Russian Gastroenterological Association, the Russian Society of Cardiology, the Association of Traumatologists and Orthopedists of Russia, the Association of Interdisciplinary Medicine, and the Russian Association of Palliative Medicine.

In our country, NSAIDs are the most important and most popular class of analgesics. Unlike global practice, Russian physicians rather rarely recommend paracetamol as a first-line drug to relieve moderate or severe pain, by giving preference to NSAIDs; the use of opioid analgesics for noncancers is minimized because of tight legal restrictions.

NSAIDs are effective and easy-to-use; however, they are far from safe; the administration of these medications may lead to serious gastrointestinal, cardiovascular, renal, and other complications in a number of cases. So the use of NSAIDs should be compulsorily monitored for adverse reactions and the choice of a specific drug for each clinical case should be based on the objective estimation of a ratio of its efficacy to safety.

In recent years, there have been fresh data on the use of NSAIDs for different diseases and a few novel representatives of this drug group have appeared on the Russian pharmacological market.

This all has necessitated a new version of the guidelines on the rational use of NSAIDs. These are based on the provisions that have high validity and have been confirmed by the results of well-organized clinical and large-scale population-based studies, as well as by their meta-analysis.

The guidelines are intended for physicians of all specialties.

клинические рекомендациинестероидные противовоспалительные препаратыэффективностьбезопасностьНПВП-гастропатияНПВП-энтеропатиякардиоваскулярные осложнениянефротоксичностьгепатотоксические реакции

clinical guidelinesnonsteroidal anti-inflammatory drugsefficacysafetyNSAID gastropathyNSAID enteropathycardiovascular eventsnephrotoxicityhepatotoxic reactions

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