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Скелетно-мышечная боль: выделение клинических фенотипов и рациональный подход к лечению

https://doi.org/10.18786/2072-0505-2019-47-042

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Аннотация

Персонализация лечения – один из центральных принципов современной медицины. При проведении терапии следует учитывать индивидуальные особенности пациента, «коморбидный фон» и, самое главное, преобладающие симптомы, а также вариант развития болезни, то есть ее клинический фенотип. Это напрямую относится к проблеме хронической скелетно-мышечной боли (СМБ), которая возникает на фоне наиболее распространенных заболеваний суставов и позвоночника. В настоящее время СМБ рассматривается как самостоятельный клинический синдром. Преобладающие механизмы развития СМБ позволяют выделять ее особые фенотипы: «воспалительный», «механический», связанный с энтезопатией и центральной сенситизацией. Очевидно, что тактика лечения фенотипов СМБ должна быть дифференцированной и основываться на индивидуальном, патогенетически обоснованном выборе медикаментозных и немедикаментозных средств с разным механизмом фармакологического действия. Для эффективного лечения «воспалительного» фенотипа необходимо применение нестероидных противовоспалительных препаратов, локальных глюкокортикоидов, базисных противовоспалительных препаратов, «механического» – коррекция биомеханических нарушений, применение препаратов гиалуроновой кислоты, «энтезопатического» – применение локальной терапии, фенотипа с центральной сенситизацией – применение препаратов для коррекции нейропатической боли (антиконвульсанты, антидепрессанты).

Об авторе

А. Е. Каратеев
ФГБНУ «Научно-исследовательский институт ревматологии имени В.А. Насоновой»
Россия

Каратеев Андрей Евгеньевич – д-р мед. наук, заведующий лабораторией патофизиологии боли и полиморфизма скелетно-мышечных заболеваний

115522, г. Москва, Каширское шоссе, 34A, Российская Федерация. Тел.: +7 (495) 109 29 10.



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Каратеев А.Е. Скелетно-мышечная боль: выделение клинических фенотипов и рациональный подход к лечению. Альманах клинической медицины. 2019;47. https://doi.org/10.18786/2072-0505-2019-47-042

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Karateev A.E. Musculoskeletal pain: determination of clinical phenotypes and the rational treatment approach. Almanac of Clinical Medicine. 2019;47. (In Russ.) https://doi.org/10.18786/2072-0505-2019-47-042

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