Lviv clinical bulletin 2020, 1(29): 13-20

The Efficiency of Complex Differential Treatment of the Patients with Systemic Lupus Erythematous Considering the Features of Bone Tissue Structure Remodeling

U. Abrahamovych, L. Tsyhanyk, O. Abrahamovych, M. Farmaha, O. Romanyuk

 Danylo Halytsky Lviv National Medical University

Introduction. Systemic lupus erythematous (SLE) is an autoimmune disease with peculiar plural and pathological processes in different organs and systems including bone tissue. Patient’s physiological, social and psychological states depend on the degree of damage of bone system. Nowadays, the issue of efficient bone treatment of the patients with SLE remains unsolved. There are no methodological recommendations which would involve a differential use of medicines considering the priority of a pathogenic factor.

The aim of the study. To find out the efficiency of differential treatment of the patients with systemic lupus erythematous considering the peculiarities of bone tissue remodeling.

Materials and methods. We have randomly involved 57 patients with prior certification and SLE diagnosis. The patients under research were females in premenopausal period with the features of the decrease of bone tissue mineral density. Control group consisted of 25 almost healthy women of appropriate age. We have done our research in two stages. The first one was dedicated to finding out the peculiarities of bone remodeling for the patients with systemic lupus erythematous and reasoning a modified complex differential treatment of the patients considering bone metabolism. The second stage consisted in the evaluation of efficiency of modified treatment complex and the comparison to the treatment efficiency and standard methods. To fulfill the second stage the patients with systemic Lupus Erythematous were divided into two subgroups: a research group consisted of the patients who received treatment according to the modified methodology when contrast group was supervised by a standard methodology. The efficiency of treatment presupposed a “subjective” evaluation, namely filling in the application of the surveys of LQ – MOS 36-Item Short-Form Healh Survey (SF-36) with statistically processed data in both groups as well as”objective”, the so-called evaluation made by the researcher of clinical and instrumental indices of the patients to and after the course of treatment having compared the data.

Results. We have discovered the specificities of bone remodeling which concern the vitamin D, the deviations of osteoblast and osteoclast functions for the patients with systemic lupus erythematous. This allows us to define 4 groups of patients: І (16 patients, 28.07 %) – with low content of vitamin D (<30.0 ng/l), preserved osteoblast and osteoclast functions, ІІ (4 patients, 7.02 %) – with the lack of vitamin D (<30.0 ng/l), with preserved osteoblast and osteoclast functions; ІІІ (16 patients, 28.07 %) – with the lack of vitamin D (<30.0 ng/l), with a weakened osteoblast and osteoclast functions; ІУ (19 patients, 33.33 %) – with the lack of vitamin D (<30.0 ng/l), with a weakened osteoblast and osteoclast functions. Considering the peculiarities of bone remodeling, we have developed an algorithm of a complex differential treatment of patients out of each subgroups: І group – calcium carbonate /calcium citrate 1000.0 mg/a day + vit D 600.0 IU/a day (Vitamin D deficiency (>20.0 ng/l)/ vit D1000.0 IU/a day (vitamin D deficiency (10.0-20.0 ng/l)/ vit D 2000.0 vitamin D deficiency (<10.0 ng/l); ІІ subgroup – calcium carbonate/calcium citrate 1000.0 mg/a day + vit D 600.0 IU/ a day (vitamin D deficiency(>20.0 ng/l)/ vit D1000.0 IU/ a day (vitamin D deficiency (10.0-20.0 ng/l)/ vit D2000.0 vitamin D deficiency (<10.0 ng/l) + alendronate 70.0 mg/a week; ІІІ subgroup – the diet enriched with calcium + alfacalcidol 1.0 mcg/24 hrs + alendronate 70.0 mg/ a week; FV subgroup – the diet enriched with calcium+ alfacalcidol 1.0 mcg/24 hrs.

Received data testify to the fact of a reliably higher efficiency of our suggested differential treatment of bones for the patients with SLE. The evaluation of the application forms of LQ proves this fact. A general score of the patients of research group has increased up to 37.93 % versus 3.19 % for the women of research group, the same has a complex objective evaluation of the results of treatment by the doctors and researchers: the patients out of research group experienced a positive result of treatment more often while the ones out of comparison group -satisfactory and negative.

Conclusions. An improved complex differential treatment of the patients with systemic lupus erythematous considering bone tissue remodeling allows us to improve the quality of life of the patients up to 37.93 % and reliably raise its efficiency of their treatment.


  1. Tsyhanyk L, Abrahamovych U, Romaniuk O. The analysis of the effect of systemic lupus erythematosus selected indicators and its treatment on bone mineral density. Lviv Clinical Bulletin. 2018;3(23):24-33. (Ukrainian).
  2. Bultink IE, Lems WF. Lupus and fractures. Curr Opin Rheumatol. 2016;28(4):426-432.
  3. Carli L, Tani C, Spera V, Vagelli R, Vagnani S, Mazzantini M et al. Risk factors for osteoporosis and fragility fractures in patients with systemic lupus erythematosus. Lupus Sci Med. 2016;3(1):e000098.
  4. Olesinska M, Saletra А. Quality of life in systemic lupus erythematosus and its measurement. Reumatologia. 2018;56(1):45-54.
  5. Sapkota S, Baig S, Hess T, O’Connell AM, Menk J, Shyne M, Fazeli P et al. Vitamin D and bisphosphonate therapy in systemic lupus erythematosus patients who receive glucocorticoids: are we offering the best care? Lupus Sci Med. 2020;29(3): e000098.
  6. TangY, Xie H, Chen J, Geng L, Chen H, Li X et al. Activated NF-kB in bone marrow mesenchymal stem cells from systemic lupus erythematosus patients inhibits osteogenic differentiation through downregulating Smad signaling. Stem Cells Dev. 2013;22(4):668-678.