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Современная ревматология

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Деструкция хряща при ревматоидном артрите , связь с функциональными нарушениями

https://doi.org/10.14412/1996-7012-2014-4-60-71

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Аннотация

В статье обсуждаются механизмы деструктивных процессов при ревматоидном артрите (РА). На овременном этапе в задачи лечения РА, помимо подавления воспаления, входит и предупреждение деструкции хряща и кости пораженных суставов. Прогнозирование деструктивных процессов при РА играет важную роль, так как необратимость функциональных изменений при РА напрямую коррелирует с выраженностью повреждения сустава. В статье обсуждаются механизмы разрушения суставного хряща и кости, значение различных биохимических маркеров для оценки степени повреждения и прогноза дальнейшего прогрессирования деструкции в мелких суставах кистей и стоп. При РА выделяют не только клинические (показатели активности), но и биологические (маркеры повреждения кости, хряща и синовиальной оболочки) предикторы повреждения суставов: СТХII – маркер деградации хряща (коллаген II типа) и CTXI – маркер деградации кости (коллаген I типа) и их динамика за 4–12 нед и более. Хотя появление эрозий считается основным признаком прогрессирования деструкции суставов при РА, показано, что в ранних стадиях болезни функциональная активность в большей степени зависит от счета сужения суставной щели (деградация хряща), чем от счета эрозий при оценке деструкции модифицированным методом Шарпа. В нескольких рандомизированных плацебоконтролируемых исследованиях (РКПИ) была оценена связь функциональной способности больных раздельно с сужением суставной щели и с числом эрозий. Было показано, что при РА деградация хряща играет большую роль в необратимой потере функции, чем деструкция кости.

Возможность подавления деградации хряща, показанная в РКПИ эффективности адалимумаба, коррелирует с лучшим функциональным исходом у больных РА. Сывороточные маркеры обмена хряща могут не только быть предикторами дальнейшего рентгенологического прогрессирования, но и использоваться для оценки эффективности терапии.

Об авторе

Наталия Владимировна Чичасова
ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России
Россия
105043 Россия, Москва, ул. Б. Пироговская, д. 2, стр. 4


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Для цитирования:


Чичасова Н.В. Деструкция хряща при ревматоидном артрите , связь с функциональными нарушениями. Современная ревматология. 2014;8(4):60-71. https://doi.org/10.14412/1996-7012-2014-4-60-71

For citation:


Chichasova N.V. Cartilage destruction in rheumatoid arthritis, its association with functional impairments. Modern Rheumatology Journal. 2014;8(4):60-71. (In Russ.) https://doi.org/10.14412/1996-7012-2014-4-60-71

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ISSN 1996-7012 (Print)
ISSN 2310-158X (Online)