V. Chemes, O. Abrahamovych, U. Abrahamovych, R. Ivanochko, L. Kobak
Danylo Halytsky Lviv National Medical University
Introduction. Patients with rheumatoid arthritis (RA) are twice as likely to have osteoporosis (OP) compared to the general population. The strength of bones depends on mineral substances, mainly represented by calcium phosphate microcrystals. The chief role in the regulation of calcium-phosphorus metabolism is played by vitamin D and parathormone (PTH).
The aim of the study. To investigate markers of calcium-phosphorus metabolism in patients with rheumatoid arthritis accompanied by bone mineral density (BMD) disorders and to find out their diagnostic value. Materials and methods. 76 patients with RA (64 premenopausal women and 12 mature men) were included in
the study. All patients with RA were subjected to ultrasound bone densitometry and according to its results, patients were divided into three groups: patients with RA and osteopenia, patients with RA and OP; RA patients without BMD disorders. The control group included 22 healthy individuals of both genders without BMD abnormalities. To evaluate calcium-phosphorus metabolism, ionized calcium, total calcium, phosphorus, PTH, and vitamin D in blood serum, and levels of calcium and phosphorus in urine were detected.
Results. It was revealed that concentration of total calcium in blood serum of patients with RA is lower compared to healthy individuals, while the same index in urine of patients with RA accompanied by osteopenia, OP or without BMD disorders is higher compared to healthy people. The concentration of vitamin D is significantly lower in
patients with RA and OP compared to patients with RA with osteopenia, without BMD disorders, or healthy individuals. The concentration of PTH is higher in healthy individuals compared to patients with RA without BMD abnormalities or with osteopenia.
Conclusions. In patients with rheumatoid arthritis with osteopenia or osteoporosis, significantly more often than in patients with rheumatoid arthritis without a violation of bone mineral density, ionized and total calcium, phosphorus in serum and urine, as well as vitamin D indices have deviations from the reference values and are of diagnostic significance.
- Andrers Album, Stefan Norrel. Introduction to мodern еpidemiology. Maty Rahu; per. from english I. Bonya. Tallinn: Institute of Experiments and Clinic. Medicine (Estonia), Dates. 1996. 122 p.) (Russian)
- Order of the Ministry of Health of Ukraine № 676 dated 12.10.2006 On approval of medical care protocols in the specialty “Rheumatology”) (Ukrainian)
- Bellan M, Pirisi M, Sainaghi PP. Osteoporosis in Rheumatoid Arthritis: role of the vitamin D/parathyroid hormone sys Rev Bras Reumatol. 2015;55(3):256-263.
- Canaff L, Hendy GN. Human calcium-sensing receptor gene. Vitamin D response elements in promoters P1 and P2 confertranscriptional responsiveness to 1,25-dihydroxyvitamin D. J Biol Chem. 2002;277:30337-30350.
- Chen B, Cheng GQ, Wang HT, Feng, Y. Increased risk of vertebral fracture in patients with rheumatoid arthritis A metaanalysis. Medicine (Baltimore). 2016;95(45):e5262.
- Cozzolino M, Lu Y, Finch J, Slatopolsky E, Dusso AS. p21WAF1 and TGF-alpha mediate parathyroid growth arrest by vitaminD and high calcium. Kidney Int. 2001;60:2109-2117.
- El Maghraoui A, Rezqi A, Mounach A, Achemlal L, Bezza A, Ghozlani I.. Prevalence and risk factors of vertebral fractures in women with rheumatoid arthritis using vertebral fracture assessment. Rheumatology (Oxford). 2010;49(7):1303-1310.
- Fardellone P, Salawati E, Le Monnier L, Goлb V. Bone loss, osteoporosis, and fractures in patients with rheumatoid arthritis: A review. J Clin Med. 2020;9(10):3361.
- Herrera A, Mateo J, Gil-Albarova J, Lobo-Escolar A, Artigas JM, Lуpez-Prats F et al. Prevalence of osteoporotic vertebral fracture in Spanish women over age 45. Maturitas. 2015;80(3):288-295.
- Hu Z, Zhang L, Lin Z, Zhao C, Xu S, Lin H et al. Prevalence and risk factors for bone loss in rheumatoid arthritis patients from South China: Modeled by three methods. BMC Musculoskelet. Disord. 2021;22(1):534.
- Jambale TA, Zahoorunnisadeeba, Halyal SS. Study of serum calcium/phosphorus in rheumatoid arthritis patients. Int J Clin Biochem Res. 2017;4(1):103-105.
- Jensen T, Hansen M, Madsen JC, Kollerup G, Stoltenberg M, Florescu A et al. Serum levels of parathyroid hormone and markers of bone metabolism in patients with rheumatoid arthritis. Relationship to disease activity and glucocorticoid treatment. Scand J Clin Lab Invest. 2001;61(6):491-501.
- Jin S, Li M, Wang Q, Zeng X, Xia W, Yu W et al. Bone mineral density and microarchitecture among Chinese patients with rheumatoid arthritis: A cross-sectional study with HRpQCT. Arthritis Res. 2021;23(1):127.
- Lee YH, Bae SC. Vitamin D level in rheumatoid arthritis and its correlation with the disease activity: a meta-analysis. Clin Exp Rheumatol. 2016;34(5):827-833.
- Lin Y-C, Li Y-H, Chang C-H, Hu C-C, Chen DW, Hsieh P-H et al. Rheumatoid arthritis patients with hip fracture: A nationwide study. Osteoporos Int. 2015;26(2):811-817.
- Mazzucchelli R, Fernandez EP, Crespн-Villarнas N, Quirуs-Donate J, Vadillo AG, Espinosa M et al. Trends in hip fracture in patients with rheumatoid arthritis: results from the Spanish National Inpatient Registry over a 17-year period (1999–2015). TREND-AR study. RMD Open. 2018;4(1):e000671.
- Nyhдll-Wеhlin BM, Ajeganova S, Petersson IF, Andersson M. Increased risk of osteoporotic fractures in Swedish patients with rheumatoid arthritis despite early treatment with potent disease-modifying anti-rheumatic drugs: a prospective general population-matched cohort study. Scand J Rheumatol. 2019;48(6):431-438.
- Phuan-Udom R, Lektrakul N, Katchamart W. Te association between 10-year fracture risk by FRAX and osteoporotic fractures with disease activity in patients with rheumatoid arthritis. Clin Rheumatol. 2018;37(10):2603-2610.
- Radu AF, Bungau SG. Management of rheumatoid arthritis: an overview. Cells. 2021;10(11):2857.
- Tsyhanyk L, Abrahamovych O, Abrahamovych U, Romaniuk O, Guta S. Analysis of the indexes of calcium and phosphorus exchange, the markers of their regulation and index of the activity of systemic lupus erythematosus. Georgian Medical News. 2020;2(299):100-106.