V. Chemes, U. Abrahamovych, L. Tsyhanyk, S. Guta
Danylo Halytsky Lviv National Medical University
Introduction. Rheumatoid arthritis (RA) is an unknown etiology of complex autoimmune pathogenesis, a chronic systemic connective disease that is often complicated by secondary osteoporosis (OS), which worsens the course and prognosis of the underlying disease.
The aim of the study. To establish the frequency and nature of bone damage in patients with rheumatoid arthritis detected by ultrasound and X-ray densitometry, to determine their diagnostic value in assessing bone mineral density.
Materials and methods. A randomized study with a preliminary stratification for RA diagnosed according to the criteria of the American College of Rheumatologists and the European League Against Rheumatism in 2010, premenopausal women and adult men, included 74 patients (62 women (84.93 %) and 12 men (15.07 %) aged 38 to 60 years (mean age at the time of the survey women – 48.67 ± 2.34 years, men – 45.42 ± 2.78) treated, receiving methylprednisolone at a dose of 4.0 to 24.0 mg/day and not receiving drugs for the treatment of OP) in the rheumatology department of the Municipal Non-Profit Enterprise of the Lviv Regional Council “Lviv Regional Clinical Hospital” from 2013 to 2019 (research group – DG). The control group (CG) was composed of 29 healthy individuals (22 women (75.86 %) and 7 men (24.14 %), the average age of women at the time of the survey was 44.95 ± 2.12 years, men – 40.71 ± 2.75 years) of the same sex and age. All patients underwent assessment of BMD with ultrasound densitometry, X-ray densitometry of the hand.
Results. In most patients with rheumatoid arthritis ultrasound densitometry revealed violations of bone mineral density, of which osteopenia was in 34 (45.95 %) patients (of whom first degree in 3 (4.05 %), second degree in 18 (24, 32.00 %), III degree in 13 (17.57 %)), osteoporosis in 22 (29.73 %), and within the reference indicators – in 18 (24.32 %).
X-ray densitometry in all patients with rheumatoid arthritis revealed a violation of bone mineral density, of which osteopenia was 46 (62.17 %), of which I degree in 19 (25.68 %), II degree in 14 (18.92 %), III degree in 13 (17.57 %)), osteoporosis – in 28 (37.83 %).
Analysis of correlations between the results of BMD assessment by ultrasound of heel bone densitometry and X-ray densitometry of the hand in patients with RA revealed a direct strong correlation between the T-test, obtained by ultrasound of heel densitometry and X-ray densitometry of the hand in patients with RA (r = 0.44; p <0.001); indicating that with a decrease in the T-test according to ultrasound densitometry will decrease the T-test according to X-ray densitometry, which allows to diagnose changes in BMD by both methods in patients with RA. It was found that in patients with RA reduction of BMD by ultrasound densitometry of the heel bone in 100.00 % of cases is confirmed by the results of X-ray densitometry of the hand (sensitivity 0.1).
Conclusions. The study demonstrated that determining the mineral density of bone tissue in patients with rheumatoid arthritis, which requires the use of available, and therefore not expensive, safe, non-invasive, without or with minimal radiation exposure, suitable for screening methods, suggests that these requirements are met methods of ultrasonic densitometry and X-ray densitometry, preferring the latter.
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