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Патогенез остеоартропатии Шарко: роль периферической нервной системы

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Нейроостеоартропатия является редким, но тяжелым осложнением периферической нейропатии. Это состояние характеризуется прогрессирующей деструкцией костей и суставов стопы и приводит к необратимой инвалидизации пациентов. На сегодняшний день безусловно лидирующей причиной нейроостеоартропатии является сахарный диабет, преимущественно с поражением стопы и голеностопного сустава. Патогенез до сих остается предметом дискуссий. Последние исследования указывают на ведущую роль системы RANK/RANKL/OPG в развитии данного осложнения. На настоящий момент отсутствуют фармакологические методы терапии с доказанной эффективностью. Со времен Жан-Мартена Шарко был достигнут лишь небольшой прогресс в лечении. Общепризнанным стандартом лечения на сегодняшний день является полная разгрузка конечности при помощи иммобилизирующей повязки из полимерных материалов. Целью этой обзорной статьи является анализ исследований, проведенных в области патогенеза остеоартропатии Шарко (ОШ), обсуждение возможного дальнейшего развития представления о природе данного состояния. Особое внимание уделено современной концепции, рассматривающей поражение нервной системы в качестве ведущего звена в развитии костной патологии. Выявление новых аспектов патогенеза ОШ способно привести к появлению фармакологических методов лечения этой группы пациентов.

Ключевые слова:
сахарныйдиабет, стопа Шарко, нервные волокна, нейропептиды, патофизиология, diabetes mellitus, Charcot joint, nerve fibres, neuropeptides, physiopathology

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The pathogenesis of Charcot osteoarthropathy: the role of the peripheral nervous system

Neuroosteoarthropathy is a rare, but devastating complication affecting patients with peripheral neuropathy. It is a progressive, destructive condition that is characterised by progressive bone and joint deterioration of the foot leading to permanent incapacity. Nowadays, diabetes mellitus is by far the most common etiology of CNO (Charcot neuro-osteoarthropathy), especially if it affects the foot or ankle. The cause of the condition is still controversial among experts. In particular, new data have emerged on the central role of RANK/ RANKL/OPG in the pathogenesis of this complication, also known as Charcot foot. No pharmacological methods of therapy have proven effective to date. Very little progress has been made in treating this condition since the days of Jean-Martin Charcot. Today, the universally accepted treatment involves completely relieving pressure from the limb using a polymer retaining bandage. The aim of this review is to analyze research into the pathogenesis of CNO and our potential to better understand the nature of this condition. Particular attention is paid to modern concept of neuroosteopathology, according to which neuropathy is crucial to developing acute osseous pathology. Revealing new aspects of CNO pathogenesis can help extend therapeutic resources for treating this patient group.

Keywords:
сахарныйдиабет, стопа Шарко, нервные волокна, нейропептиды, патофизиология, diabetes mellitus, Charcot joint, nerve fibres, neuropeptides, physiopathology