urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/umj.24.1.39EGZFLTurmj-1723Research ArticleОригинальные статьи | Original articlesOriginal articlesДоклиническая стадия гонартроза. Перспективы ранней хондропротективной терапииSubstantiation of the Preclinical Stage of Gonarthritis. Prospects for Early Chondroprotective Therapyhttps://orcid.org/0000-0002-0468-4732АршинЕ. В.ArshinE. V.

Евгений Владимирович Аршин — доктор медицинских наук, профессор кафедры госпитальной терапии и кардиологии

Пермь

Evgeny V. Arshin — Doctor of Sciences (Medicine), Professor of the Department of Hospital Therapy and Cardiology

Perm

1ewa1@mail.ruhttps://orcid.org/0009-0007-4344-0259ГоршковД. А.GorshkovD. A.

Данил Анатольевич Горшков — аспирант кафедры госпитальной терапии и кардиологии;

ревматолог отделения первичной специализированной медико-санитарной помощи

Пермь

Danil A. Gorshkov — Postgraduate Student of the Department of Hospital Therapy and Cardiology;

Rheumatologist of the Department of Primary Specialized Health Care

Perm

danilgorshcov@yandex.ruhttps://orcid.org/0009-0001-9388-7573РадощёкинМ. А.RadoshchekinM. A.

Михаил Александрович Радощёкин — ревматолог

Чайковский

Mikhail A. Radoshchekin — Rheumatologist

Tchaikovsky

radoshchekin87@mail.ruhttps://orcid.org/0000-0003-4860-0112ХлыноваО. В.KhlynovaO. V.

Ольга Витальевна Хлынова — доктор медицинских наук, профессор, член-корреспондент Российской академии наук, заведующий кафедрой госпитальной терапии и кардиологии

Пермь

Olga V. Khlynova — Doctor of Sciences (Medicine), Professor, Corresponding Member of the Russian Academy

of Sciences, Head of the Department of Hospital Therapy and Cardiology

Perm

olgakhlynova@mail.ruПермский государственный медицинский университет имени академика Е. А. ВагнераРоссияPerm State Medical University named after Academician E. A. WagnerRussian FederationПермский государственный медицинский университет имени академика Е. А. Вагнера; Клиническая больница Свердловского районаРоссияPerm State Medical University named after Academician E. A. Wagner; Clinical Hospital of the Sverdlovsk DistrictRussian FederationМедицинский центр «Вита-Д»РоссияMedical Center “Vita-D”Russian Federation20250203202524139–49Copyright © Аршин Е.В., Горшков Д.А., Радощёкин М.А., Хлынова О.В., 20252025Аршин Е.В., Горшков Д.А., Радощёкин М.А., Хлынова О.В.Arshin E.V., Gorshkov D.A., Radoshchekin M.A., Khlynova O.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1723

Актуальность. Гонартроз (ГА) является существенной медицинской проблемой. Поздняя диагностика ГА, основанная на рентгенологических критериях, определяет снижение эффективности хондропротективных препаратов (ХП).Цель — ультрасонографическим методом выявить ранние изменения гиалинового хряща (ГХ) коленных суставов и оценить структурно модифицирующее влияние хондропротективной терапии на раннюю стадию заболевания.Материалы и методы. На первом этапе обследовано 186 пациентов с высоким риском развития ГА без клинико-рентгенологических признаков заболевания с остеоартритом иной локализации, кроме коленных суставов, верифицированной дорсопатией и ожирением. В контрольную группу вошел 31 здоровый человек без факторов риска развития ГА. На втором этапе 119 пациентов без верифицированного на момент начала исследования ГА в течение 2 лет принимали ХП, 67 пациентов оставались под наблюдением также 2 года, но без приема ХП. Исходно и через 2 года всем проводилось ультразвуковое исследование КС. Оценивалась динамика минимальной толщины ГХ, определяемая при измерении в 8 фиксированных зонах.Результаты. Через 2 года толщина ГХ в контрольной группе уменьшилась до (2,84±0,16) мм и не имела статистически значимых различий от исходного значения. В группе сравнения, в которой пациенты не принимали ХП, ГХ снизился на (0,24±0,15) мм, что в 2,7 раза больше, чем в группе пациентов, получавших ХП, и в 4,8 раза больше, чем в контрольной группе (p = 0,01). В группе, получавшей ХП, минимальная толщина ГХ снизилась на (0,09±0,12) мм и была сопоставима с показателями контрольной (p = 0,49).Выводы. У пациентов высокого риска ГА определяется исходно низкая минимальная толщина ГХ и отмечается его интенсивная потеря в сравнении с контролем. Применение ХП у пациентов с высоким риском ГА позволяет предотвратить потерю ГХ на ранней доклинической стадии.

The relevance of the problem. Late diagnosis of gonarthritis (GA) based on radiological criteria determines a decrease in the effectiveness of chondroprotective drugs (CD).The aim is to identify early changes in the hyaline cartilage of the knee joints and evaluate the effectiveness of chondroprotective therapy at an early stage of the disease.Materials and methods. 186 patients with high risk of GA were examined. All patients signed an informed consent. 119 patients took CD for two years, 67 patients did not receive therapy. The control group consisted of 31 healthy people without GA risk factors. Initially and 2 years later, everyone underwent ultrasound examination of the knees. The dynamics of the minimum thickness of hyaline cartilage (HC) was evaluated.Results. After 2 years, the HC height in the control group decreased to (2.84±0.16) mm and had no statistically significant differences from the initial value. In the comparison group in which patients did not take CD, HC decreased by (0.24±0.15) mm, which is 2.7 times more than in the group of patients receiving CD and 4.8 times more than in the control group (p = 0.01). In the group receiving CD, the minimum thickness of HC decreased by (0.09±0.12) mm and was comparable with the indicators of the control group (p = 0.49).Conclusions. In patients at high risk of GA, an initially low minimum cartilage thickness is determined, and its intensive loss is noted, compared with the control. The use of CD in patients at high risk of GA prevents the loss of HC at an early preclinical stage.

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