Osteoarthritis is caused by a complex interplay of genetic, metabolic, immunological, inflammatory, biochemical, and biomechanical factors. In recent years, a fairly large number of studies have been devoted to the role of cellular factors of the immune system in the development of osteoarthritis. The aim of the study was to analyze scientifc publications devoted to the study of cellular factors in the pathogenesis of osteoarthritis and to assess their signifcance in the development of joint pathology. Material and methods. The search for publications by keywords was carried out in the PubMed, Google Scholar, eLibrary databases and specialized journals related to therapy, rheumatology, traumatology and immunology from 2000 to 2022. Results and discussion. Summarizing modern ideas about the role of cellular factors of the immune system in the pathogenesis of osteoarthritis, it is necessary to note the presence of synovial inflammation, a key role in the development of which is assigned to macrophages. At the same time, patients with osteoarthritis are characterized by the predominance of classically activated macrophages with a pronounced pro-inflammatory effect. In addition, T lymphocytes also play an important role in the pathogenesis of joint damage. Among them, a special role is given to T helper cells, cytotoxic T lymphocytes and memory T cells. An imbalance of cytokines and chemokines produced by subpopulations of T lymphocytes is the reason for triggering a number of mechanisms for the onset and progression of osteoarthritis. A signifcant role in the development and progression of osteoarthritis is also assigned to neutrophils, which contribute to the development of inflammation. Neutrophil-produced elastase enhances cartilage degradation, chondrocyte apoptosis, unbalanced subchondral bone remodeling, and osteophyte formation. Conclusions. Knowledge of the role of cellular immune factors in the pathogenesis of osteoarthritis and ways to implement their effects determines the prospects for the use of immunotropic agents. Also, it should be taken into account that the occurrence and progression of osteoarthritis is due to the simultaneous combination of the influence of a wide range of various components, including risk factors, traumatic joint injury, etc.
Today, large-scale studies of various aspects of osteomyelitis and the search for new methods of treatment did not prevent us from failure to achieve infection eradication in a big part of osteomyelitis patients. Often, we are not able to fully restore the function of the affected part of the body. A special problem of recent decades is implant-associated osteomyelitis since the number of hardware implanted by trauma and orthopedic surgeons continues to rise every year, and the frequency of postoperative infectious complications does not decrease despite all efforts to prevent them. The social significance of osteomyelitis is difficult to overestimate. This is not only a large cost to the health system for the treatment of patients, but also a decrease in the quality and life expectancy of patients. Perhaps our failures in the treatment of osteomyelitis are due to our incomplete understanding of the etiology and pathogenesis of the disease and the inconsistency of interdisciplinary interaction. This lecture summarizes the current understanding of the etiology and pathogenesis of osteomyelitis, the most popular classifications of the disease both in terms of age and etiology, the route of infection into the bone, the clinical course, the anatomical type of bone damage and the physiological class of patients.
Over the past decades, there has been a steady increase in the incidence of osteomyelitis. It is associated with an increased use of implants in traumatology and orthopedics. The social aspects of osteomyelitis are, on the one hand, significant financial costs for the healthcare system, and on the other hand, high recurrence and re-infection in the treatment of joint pathology associated with long-term loss of work ability and a high risk of patient’s disability. Purpose To conduct a search and analysis of publications in Russian and English, devoted to the problem of osteomyelitis and periprosthetic infection, on the basis of which to summarize the main current notions about the etiology, pathogenesis, diagnosis and treatment of osteomyelitis. Materials and methods The search was carried out in the Pubmed and CyberLeninka databases of literature sources over the past 10 years. The data were analyzed and compared with the materials from earlier publications. Only publications from peer-reviewed journals were considered for analysis. Results and discussion Success in the treatment of peri-implant infection with prosthesis re-implantation and satisfactory joint function has been achieved in only just more than a half of patients. Recent studies have significantly changed the understanding of the etiology and pathogenesis of osteomyelitis. It has been proven that in osteomyelitis and implant-associated infection, four reservoirs of infection are formed in the patient's body: abscesses in soft tissues and bone marrow canal, biofilms on the surface of implants and necrotic tissues, intracellular colonization with bacteria of the macroorganism and lacunar-canalicular system. Understanding the mechanisms of osteomyelitis development and its course forces the specialists to take a fresh look at the causes of failures in the fight against such a severe pathology and change approaches to its prevention, diagnosis and treatment.
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