ssmuБюллетень сибирской медициныBulletin of Siberian Medicine1682-03631819-3684Siberian State Medical University, the Ministry of Healthcare of the Russian Federation10.20538/1682-0363-2018-2-167-174ssmu-1214Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEW AND LECTURESПатогенетические основы таргетной терапии рецидивирующего полихондритаPathogenetic mechanisms of biological agents in managing of relapsing polychondritishttps://orcid.org/0000-0002-2220-7745ХалеваЕ. Г.KhalevaE. G.

ассистент, кафедра педиатрии им. профессора И.М. Воронцова,

194100, г. Санкт-Петербург, ул. Литовская, 2

Assistant, Department of Paediatrics,

2, Litovskaya Str., Saint-Petersburg, 194353

https://orcid.org/0000-0002-7571-5460НовикГ. А.NovikG. A.

д-р мед. наук, профессор, зав. кафедрой педиатрии им. профессора И.М. Воронцова,

194100, г. Санкт-Петербург, ул. Литовская, 2

DM, Professor, Head of the Department of Paediatrics,

2, Litovskaya Str., Saint-Petersburg, 194353

ga_novik@mail.ruhttps://orcid.org/0000-0003-2159-2722РохлинаФ. В.RokhlinaF. V.

ассистент, кафедра педиатрии им. профессора И.М. Воронцова, 194100, г. Санкт-Петербург, ул. Литовская, 2;

врач-ревматолог, консультативно-диагностический центр, 196603, г. Санкт-Петербург, Пушкин, ул. Парковая, 64–68

Assistant, Department of Paediatrics, 2, Litovskaya Str., Saint-Petersburg, 194353;

Rheumatologist, 64-68, Parkovaya Str., Pushkin, Saint-Petersburg, 196603

Санкт-Петербургский государственный педиатрический медицинский университет (СПбГПМУ)РоссияSaint-Petersburg State Pediatric Medical UniversityRussian FederationСанкт-Петербургский государственный педиатрический медицинский университет (СПбГПМУ); Научно-исследовательский детский ортопедический институт (НИДОИ) имени Г.И. ТурнераРоссияSaint-Petersburg State Pediatric Medical University Research Сhildren’s Orthopedic Institute named after G.I. TurnerRussian Federation201820072018172167174Copyright © Халева Е.Г., Новик Г.А., Рохлина Ф.В., 20182018Халева Е.Г., Новик Г.А., Рохлина Ф.В.Khaleva E.G., Novik G.A., Rokhlina F.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://bulletin.ssmu.ru/jour/article/view/1214

Рецидивирующий полихондрит (РП) – редкое аутоиммунное заболевание, характеризующееся рецидивирующим воспалением хрящевой и других, богатых протеогликаном тканей организма. Сопутствующие заболевания, в частности миелодисплазия или cистемные аутоиммунные заболевания, могут быть обнаружены у одной трети пациентов с РП. В отличие от взрослых у детей РП реже ассоциирован с другими аутоиммунными заболеваниями. Диагноз РП устанавливается с использованием критериев Mc Adam (1976) или Damiani (1979).

Основой патогенеза РП является аутоиммунная реакция, которая первоначально направлена против хряща и далее распространяется на нехрящевые ткани. Одним из звеньев патогенеза РП является механическая травма хряща, приводящая к высвобождению провоспалительных цитокинов (фактор некроза опухоли-α, интерферон-γ, IL-8 и макрофагальный воспалительный белок 1) и локальному воспалению с последующим образованием аутоантител у пациента с генетической предрасположенностью. В лечении РП используют стероиды, нестероидные противовоспалительные препараты, колхицин и, если они неэффективны, то назначают иммунодепрессанты. Наиболее эффективными антицитокиновыми препаратами, используемыми в лечении РП, являются ингибиторы фактора некроза опухоли-α, антагонисты рецептора IL-1, ингибитор ко-стимулирующего пути активации Т-лимфоцитов, моноклональные антитела против рецептора IL-6. Учитывая сложность ведения таких пациентов, целью данного обзора было осветить последние данные о патогенетических основах антицитокиновой терапии РП. 

Relapsing polychondritis (RPC) is an autoimmune disease characterized by the inflammation of cartilaginous tissues and other proteoglycan rich tissues. A concomitant disease, particularly myelodysplasia or systemic autoimmune disease can be detected in one-third of the patients with RPC. Unlike adults in children, RPC is less often associated with other autoimmune diseases. The diagnosis of RPC is established using the criteria of Mc Adam (1976) or Damiani (1979). The basis of the pathogenesis of RPC is an autoimmune reaction, which is initially directed against cartilage and then spreads to non-cartilaginous tissues. One of the elements in the pathogenesis of RPC is the mechanical trauma of cartilage, resulting in the release of pro-inflammatory cytokines (tumor necrosis factor alpha, interferon-γ, interleukin-8, and macrophage inflammatory protein 1) and local inflammation followed by the formation of autoantibodies in a patient with a genetic predisposition. In the treatment of RPC, steroids, non-steroidal anti-inflammatory drugs, colchicine are used and, if they are ineffective, immunosuppressants are prescribed. The most effective anti-cytokine drugs used in the treatment of RPC are tumor necrosis factor-alpha (TNF-α) inhibitors, IL-1 receptor antagonists, an inhibitor of the costimulatory pathway of T-lymphocyte activation, monoclonal antibodies against the IL-6 receptor. Given the fact that management of these patients is very complex, the aim of the study is to review available data on pathogenetic mechanisms of biological agents in managing of relapsing polychondritis.

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