FEATURES OF CHANGES OF MINERAL BONE DENSITY IN PATIENTS WITH RHEUMATORY ARTHRITIS IN COMBINATION WITH NONALCOHOLIC STEATOHEPATITIS

Abstract

SUMMARY. RA has a special place among the diseases leading to the development of osteoporosis. Osteoporosis in RA is a consequence of the existing chronic systemic disease, and therapy with glucocorticoids. There wasn’t conducted of the study relationship between morphological and functional disorders of the liver and BMD in patients with RA.

The aim of the study – to investigate violations of structural-functional state of bone tissue and to identify the dependence of changes of mineral density of bone tissue from the presence of NASH, or lack there of, using x-ray densitometry in patients with RA.

Materials and Methods. Examination of patients was carried out according to traditional methods and included: 1) the general clinical: examination, survey, history of fractures, their number and the circumstances of their occurrence, determination of BMD; 2) laboratory (General and biochemical blood analysis, determination of RF by latex agglutination, the assessment of the titer of anti-CCP by ELISA (diagnostic limit ≥15 mind. units/ml); 3) mineral density of bone tissue was determined using dual x-ray densitometer DRG-A (Dualenergy X-Ray Absorptiometry) of the firm LUNAR (USA) at the level of the lumbar spine. Patients BMD at the level of the lumbar spine ≤ -2.5 SD, was diagnosed with osteoporosis; patients in whom the level of BMD < -1 SD and ≥ -2.5 SD osteopeny; index Z (deviation of bone mineral density from the mean value in patients of appropriate age), T (deviation from the reference values for peak bone mass in healthy young adults); 4) statistical.

Results. Densitometric indicators in a cohort of patients with NASH show a significant decrease BMD in comparison with patients without liver damage. The majority of women in RA with concomitant liver in postmenopausal period have noted the phenomenon of osteopenia and osteoporosis (OP). Among patients with minimal activity of RA in combination with NASH had a small number of the examined women with osteoporosis, patients with rheumatoid arthritis II degree of activity their share with osteopenia and osteoporosis were distributed with small differences, although the percentage was dominated by patients with osteopenia. The greatest number of patients, which amounted to a group of maximum RA activity, was presented with osteoporosis. Osteogenic conditions was associated with obesity in RA patients with NASH. Under the terms of the positivity of anti-CCP the number of patients with osteoporosis was significantly higher than with normal mineral bone density and osteopenia. Patients with seropositive RA had a statistically significant high risk of osteogenic conditions and often suffered from osteoporosis than those with seronegative RA. In a larger cohort of patients with RA in combination with NASH was diagnosed with fractures in anamnesis: osteopenia 6 (10.34%) patients, of osteoporosis – 12 (20.69 %) of patients.

Conclusions. Thus, it is demonstrated that among patients with RA with concomitant fatty liver disease was diagnosed phenomena osteopenia and osteoporosis in 87.93 % of cases. The study of structural-functional state of bone tissue of the lumbar spine in women with RA before menopause and in postmenopausal period with concomitant fatty liver disease was compared with patients who had concomitant liver showed a significantly higher percentage of development osteogenic states, which was associated with concomitant obesity, activity of RA, the presence of anti-CCP and RF quantitative values and frequency of data recording conditions.