V. Chemes, O. Abrahamovych, U. Abrahamovych, O. Fayura, N. Drobinska, L. Kobak

Danylo Halytsky Lviv National Medical University

Introduction. Osteoporosis (OP) is one of the most common causes of disability decrease in life expectancy among the elderly. The main risk factors for the occurrence of osteoporosis in patients with rheumatoid arthritis (RA) include family predisposition, female sex, age, the presence of menopause, chronic inflammatory process and its treatment. The current task remains the assessment of risk factors for the occurrence of OP in patients with RA, and there is also the need to assess risk factors for the occurrence of OP in patients with RA based on the results of laboratory parameters of calcium-phosphorus metabolism and markers of bone remodeling, which will improve the diagnosis of bone mineral density (BMD) disorders.

The aim of the study. To determine the indicators of calcium-phosphorus metabolism and bone remodeling as risk factors for the occurrence of bone mineral density disorders in patients with rheumatoid arthritis.

Materials and methods. To the study randomlywere enrolled 76 patients with RA (64 women (84.21%) in the premenopausal period and 12 men (15.78%) aged from 38 to 60 years old (the average age at the time of examination of women – 48 .67 ± 2.34 years, men – 45.42 ± 2.78)), treated (receiving methylprednisolone according to the scheme at a dose of 4.0 mg/day and a short course during an exacerbation up to 24.0 mg/ and not receiving drugs for the treatment of BMD disorders). All patients underwent an assessment of BMD using ultrasound bone densitometry of the calcaneus, indicators of calcium-phosphorus metabolism and markers of bone remodeling were determined. Based on the obtained results, the patients were stratified into the following three groups: 1) 18 patients (15 women (83.33%) and 3 men (16.67%) aged 38 to 52 years) with RA without BMD disorders – comparison group (CPG); 2) 34 patients (31 women (91.18 %) and 3 men (8.82 %) aged 38 to 54 years) with RA and osteopenia – study group 1 (SG1);: 3) 24 patients (18 women (75.00%) and 6 men (25.00%) aged 41 to 53 years) with RA and OP – study group 2 (SG2). The control group (CG) consisted of 22 practically healthy individuals.

Results. Patients with RA without BMD disorders significantly more often observed a decrease in the content of total calcium (p<0.015) and ionized calcium (p<0.000) in the blood serum. As well as a decrease in the individual indicator of osteocalcin (OK) (р<0.000). Constellations of indicators of calcium-phosphorus metabolism and markers of bone remodeling were also analyzed and it was found that the risk of belonging to CPG if there is a constellation of reduced OC and/or reduced total Ca in blood serum is significantly higher (p < 0.005).

In RA patients with osteopenia, a decrease in urinary phosphorus indicates that the risk of osteopenia in RA patients is significantly higher than in RA patients, in whom these indicators will be within the reference values (p < 0.000).

For OP in patients with RA, an increase in ionized calcium and a decrease in phosphorus in the urine indicate that the risk of having OP is significantly higher (p <0.050) compared to RA patients in whom these indicators are normal.

According to the obtained data, an increase in the β-CrossLaps index in patients with RA is a risk factor for the occurrence of osteopenia and OP, p<0.050.

All possible variants of the constellations of calcium-phosphorus metabolism indicators and markers of bone remodeling were also analyzed and it was found that the constellation of reduced OC and increased ionized calcium has a strong correlation and is a risk factor for the occurrence of OP in patients with RA (p<0.023)

Conclusions. The risk of belonging to the group of patients with rheumatoid arthritis without a violation of the mineral density of bone tissue is significantly higher if there is: a statistically significant decrease in the content of blood serum total calcium only or ionized calcium only, or reduction only osteocalcin indicator, or a simultaneous decrease in the content indicators of total calcium and osteocalcin in blood serum. The risk of belonging to the group of patients with rheumatoid arthritis with osteopenia is significantly higher if there is: a statistically significant decrease in the content of phosphorus in the urine or an increase in the content of C-terminal telopeptide in the blood serum, specific for the degradation of type I collagen in tissue. The risk of belonging to the group of patients with rheumatoid arthritis with osteoporosis is significantly higher if there is: a statistically significant increase in the serum level of only ionized calcium or a decrease in the content of phosphorus in the urine only, or only an increase in the serum level of C-terminal telopeptide specific for collagen degradation I type in the tissue, or a simultaneous increase in the level of ionized calcium in the blood serum and a reduced level of osteocalcin.

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