Lviv clinical bulletin 2019, 1(25): 51-62

Peculiarities of Calcium-Phosphorus Metabolism and Bone State in Patients with Rheumatoid Arthritis: Pathogenesis, Diagnosis and Principles of Differential Treatment (Literature Review and Clinical Case Description)

V. Chemes, O. Abrahamovych, U. Abrahamovych, L. Tsyhanyk, S. Guta

Danylo Halytsky Lviv National Medical University

Introduction. Significant prevalence of rheumatoid arthritis (RA), an unceasing increase in morbidity, affliction of working age population, late diagnosis, not always effective treatment and large economic damage due to this disease and its complications, are the actual problems in medical field and should be further explored.

The aim of the studi. To make the review of the literature and the description of the clinical case devoted to finding out the features of pathogenesis, diagnosis and principles of differentiated treatment of calcium­phosphorus metabolism and bone state in patients with RA.

Materials and methods. The content analysis, the method of system and comparative analysis, the bibliosemantic method of studying the actual scientific research of the features of calcium­phosphorus metabolism and the state of bones in patients with RA, pathogenesis, diagnostic methods and principles of differentiated treatment were used. The search for the sources was carried out in the scientific­medical databases: PubMed­NCBI, Medline, CochraneLibrary, EMBASE, ResearchGate by keywords: RA, osteoporosis, RANK / RANKL / OPG, densitometry, P1NP, calcium, phosphorus, vitamin D, parthyroid hormone. In total, 75 sources in English and Ukrainian have been analyzed. The selected sources highlight the pathogenesis, diagnostic methods with proven high sensitivity and specificity, treatment principles. In addition, the clinical case is described.

Results. RA and its complications, which are mostly the result of calciumphosphorus exchange disorders, lead to early disability of people of working age, due to the occurrence of fractures. Clinical signs of osteoporosis in patients with RA are often nonspecific and diagnosed untimely. Therefore, the issue of early diagnosis and treatment principles is still relevant.

Conclusions. The overview of modern literature and the description of the clinical case suggest that patients with rheumatoid arthritis exhibit the significant disturbances in calcium­phosphorous metabolism with bone defeat, but the information on pathogenetic mechanisms, optimal methods for diagnosis of osteoporosis and its treatment are insufficient, and sometimes contradictory. That is why there is a need to continue the research in this direction.


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