Urolithiasis is one of the most actual public health problems world-wide, its prevalence is growing annually. Study of the problem of urolithiasis appeared in recent years to a new level due to changes in the multidisciplinary approach and the principles of evidence-based medicine. Expanding the study of etiology and pathogenesis of the disease, development and application of high-tech diagnostic and treatment methods have enabled solve many problems and deliver new ones, identify prospects for future scientific and practical works. The article provides an overview of modern data concerning the etiology and pathogenesis of urolithiasis.
Objectives Evaluation of changes in bone mineral density (BMD) in patients with rheumatic diseases. Methods A retrospective analysis of protocols of X-ray densitometry was performed in patients who were at the dispensary observation in the Rheumatologic Centre of Kazan City in the period from January 2010 to January 2011. The changes of BMD in two points were taken into account: the lumbar spine and proximal femur. T-score was evaluated in postmenopausal women and men older than 50 years. Z-test was evaluated in women before menopause and men younger than 50 years. 347 patients were included in analysis. 231 of them had rheumatoid arthritis (RA), 63 – ankylosing spondylitis (AS) and 53 had osteoarthritis (OA). Results 85 (24.5%) of 347 patients (74 women and 11 men) had osteoporosis and 143 (41.8%) patients (121 women and 21 men) had osteopenia according to the criteria of WHO. Distribution by rheumatic diseases was as follows. 55 (23.8%) of 231 patients with RA had osteoporosis and 89 (38.5%) – osteopenia. 13 (20.6%) of 63 patients with the AS had osteoporosis and 32 (50,8%) – osteopenia. Osteoporosis and osteopenia were revealed in 17 (32.1%) and 24 (45.3%) of 53 patients with OA, respectively. Conclusions Osteoporosis is often met in rheumatic diseases, especially in RA and AS. However, the prevalence of osteopenia is even higher and this situation requires the actions for prevention of osteoporosis and fractures. In addition, osteoporosis and osteopenia in OA were observed much more often than it was thought previously. Disclosure of Interest None Declared.
Цель наблюдения -оценка эффективности и переносимости адалимумаба у больных РА как при монотер апии, так и в комбина-ции с базисными противовоспалительными препаратами (БПВП)
ObjectivesTo determine and compare the pattern of change in bone mineral density (BMD) in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS).MethodsThe study involved 52 patients with definite diagnosis of RA (1987 criteria.): women - 28 (53.8%), men - 24 (46.2%), aged 25 to 67 years (mean age 42,5±11, 3), with duration of disease - 8,2±6,7 years. Also, 58 patients were examined with documented diagnosis of AS according to ASAS (men - 33 (56.9%), women - 25 (43.1%), mean age 44,1±8,2 years, mean disease duration - 6 9±3,9 years. no significant differences by sex and age in these groups have been identified.ResultsAccording to the world criteria when evaluating BMD in the lumbar spine in patients with RA normal BMD was observed in 8 (15.4%) patients, osteopenia - in 29 (55.8%) and OP - in 15 (28.8%) people. In the femoral neck BMD was observed normal in 15 (28.8%) patients with rheumatoid arthritis, osteopenia - in 24 (46.2%) and OP - 13 (25.0%) patients. Among AS patients normal BMD was observed in 10 (17.2%) patients, osteopenia - in 33 (56.9%) and OP - in 15 (25.8%) patients. In the proximal femur BMD normal occurred in 12 (20.7%) patients with rheumatoid arthritis, osteopenia - in 32 (55.2%) and OP - in 14 (24.1%) patients. When comparing BMD at 3 points was found that patients with RA BMD was significantly lower (p<0,01) at the femoral neck (0,87±0,18) and distal forearm (0,81±0,32), than AS patients (BMD at the femoral neck 0,90±0,18; in the distal forearm 0,85±0,29). For lumbar spine BMD similar differences in the two groups were established, but they were not significant. In assessing the functional status was found that patients with RA high index HAQ, the number of tender and swollen joints was significantly (p<0,05) correlated with a more pronounced decrease in BMD in the spine and femoral neck. In AS similar correlation was observed in the spine, but was not significant.ConclusionsIn this study, it was shown that decreasing BMD observed in a significant number of patients with RA and AS. In RA, decrease in spine BMD was significantly correlated with reduced functional status and increased number of tender and swollen joints. In AS this relationship was not significant.Disclosure of InterestNone declared
ObjectivesTo rate 10-year probability of osteoporotic fractures based on bone mineral density (BMD) at the femoral neck.MethodsThe study included 70 patients (35 men and 35 women), aged 40-90 years, who applied to the largest clinics in Kazan for various reasons during the period from January to September 2014. In each of the 7 clinics (number locales) were randomly selected 10 patients (5 men and 5 women). All patients were invited for a visit to a rheumatologist for risk assessment and calculation of the 10-year probability of osteoporotic fractures (general and hip) through the FRAX validated for these purposes. Calculated on the basis taken epidemiological prevalence of risk factors in the Russian population. All the patients underwent dual-energy X-ray absorptiometry at Hologic densitometer with the definition of BMD at the femoral neck. Next was calculated the 10-year probability of fracture-adjusted BMD at the femoral neck. Threshold intervention (beginning antiosteoporotic therapy) was considered the 10-year probability of fracture over 20% for all sites of fractures and/or more than 3% for hip fractures.ResultsThe average age of the patients was 61,8±21,3 years (women - 59,2±23,5 years, men - 63,5±18,1 years). The probability of fracture in all locations in the next 10 years, more than 20% was observed in 15 (21.4%) patients: 11 (31.4%) women and 4 (11.4%) men. The probability of hip fracture within 10 years more than 3% was detected in 13 (18.5%) patients (10 (28.6%) women and 3 (8.6%) men). After adding in the program FRAX values at the femoral neck BMD increased number of patients with a 10-year probability of fracture in all locations more than 20% (19 (27.1%) patients: 13 (37.1%) women and 6 (17.1%) men) and the femoral neck over 3% (20 (28.6%) patients: 13 (34.3%) and 7 women (20%) men).ConclusionsThe program allows to estimate the FRAX 10-year probability of osteoporotic fractures and to determine the threshold of intervention in individuals at risk. The advantage of this program is the ability to determine the likelihood of fractures in the absence of information about the BMD at the femoral neck. However, knowing the value of BMD significantly increases the sensitivity of the method.Disclosure of InterestNone declared
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