«Малая ревматология»: несистемная ревматическая патология околосуставных мягких тканей области таза и нижней конечности – диагностика и лечение. Часть 3

Боль, связанная с ревматической патологией околосуставных мягких тканей (РПОМТ) таза и нижней конечности – нередкая причина обращения к врачам общей практики и ревматологам. Однако истинная причина болевых ощущений подчас ускользает от внимания врача, и пациент долго и часто безуспешно лечится по поводу «люмбалгии», «коксартроза» или «гонартроза».

Сложности топической диагностики во многом связаны с тем, что инструментальные методы практически всегда определяют те или иные дегенеративные изменения в поясничном отделе позвоночника и тазобедренном суставе (ТБС), что формально подтверждает наличие неспецифической боли в нижней части спины и коксартроза. Провести дифференциальную диагностику этих состояний возможно, если рассмотреть особенности клинической картины, разграничив при этом такие симптомы, как боль в спине, боль в области ягодиц, а также боль, локализующаяся преимущественно по наружной стороне бедра и паховой области.

К наиболее известным формам РПОМТ области таза и ТБС относятся трохантерит, синдромы абдукторов и аддукторов бедра, подвздошно-гребенчатый бурсит и бурсит седалищного бугра.

В настоящем обзоре кратко представлены основные формы РПОМТ указанной области, их клинические проявления и методы топической диагностики. Рассмотрены основные терапевтические подходы: применение нестероидных противовоспалительных препаратов, локальных инъекций глюкокортикоидов и обогащенной тромбоцитами плазмы, физиотерапии.

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