Background and objective:Body weight and body mass index (BMI) are considered potentially modifiable determinants of bone mass. Therefore, the aim of this study was to explore the association between body weight and body mass index (BMI) with total hip and lumbar spine bone mineral density (BMD).Methods:This cross-sectional study included a population of 100 women and 32 men from Kosovo into three BMI groups. All the study subjects underwent dual-energy X-ray absorptiometry (DXA) measurements.Results:Total hip BMD levels of obese menopausal and premenopausal women and men were significantly higher compared to overweight or normal weight subjects, while lumbar spine BMD levels of only menopausal women and men were higher among obese subjects. Age-adjusted linear regression analysis showed that BMI is a significant independent associate of lumbar spine and total hip BMD in menopausal women and men.Conclusion:Despite positive association between BMI and lumbar spine and total hip BMD in menopausal women, presence of more obese and osteoporotic subjects among menopausal women represent a population at risk for fractures because of poor balance and frequent falls; therefore, both obesity and osteoporosis prevention efforts should begin early on in life.

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Objective: Rheumatoid arthritis (RA) is a chronic inflammatory and destructive joint disease that affects 0.5-1% of the world's population and commonly leads to significant disability and consequent impairment of quality of life. Osteoporosis is an early and common feature in RA and occurs during the course of the disease as extra-articular manifestation of rheumatoid arthritis, which may result in increased risk of fractures, morbidity, and mortality. The aim of this study was to evaluate changes in bone mineral density in patients with early-onset rheumatoid arthritis including its correlation with disease activity. Method: Ther study was performed with 50 patients diagnosied as early-onset rheumatoid made less than two years ago n the Private Clinic "Rheuma", who fulfilled the diagnostic criteria of American College of Rheumatology/ European League Against Rheumatism and 30 healthy volunteers as controls. Bone mineral density of these patients was measured at lumbar spine and hip by using dual energy x-ray absorptiometry scan (DEXA Stratos 800). Demographic and clinical data including age, gender, BMI, menstrual status, disease duration, laboratory tests, and disease activity scale (DAS28) scores were collected. Results: From a total of 50 patients with RA, 36 were females and 14 were males with an overall mean age of 27-57 (33.7±7.87 years), fulfilling ACR/EULAR Criteria. The patients with RA, had osteoporosis (16%), osteopenia (65%) and normal BMD (30%) values. In the group of RA patients with osteoporosis had higher disease activity scores (DAS-28) without any statistically significant correlation compared to RA patients with normal BMD values or osteopenia. Conclusion: Patients with RA are more likely to have bone loss compared to normal age subjects. Lower BMD values were found in patients at earlier stage of the rheumatoid arthritis with higher disease activity. Dual energy x-ray absorptiometry is an important tool to assess BMD in early RA patients.

After the breakthrough in the treatment of rheumatoid arthritis and numerous related disorders with biological therapies targeting TNFa at the Kennedy Institute in London Millions of patients have tremendously benefitted. However, we cannot cure these diseases yet and have to search for additional therapeutic targets. Since it was shown that synovial fibroblasts (SF) are not only effector cells responding to inflammatory stimuli, but appear endogenously activated and potentially involved into spreading the disease [1], we searched for the epigenetic modifications leading to the activated phenotype of these cells. Epigenetics in its scientific definition "is the study of all heritable and potentially reversible changes in genome function that do not alter the nucleotide sequence within the DNA", but might be considered in simpler terms as the regulation of gene expression. Epigenetic modifications include: Acetylation, Methylation, Phosphorylation, Sumoylation, miRs or microRNAs. Our laboratory is studying these processes and we have found that RASF reside in a hyperacetylated synovial tissue and appear hypomethylated [2]. Hypomethylation leads to the activated phenotype of RASF which is characterized by the production of matrix-degrading enzymes and of potent chemokines induced by Toll-like receptor signalling. Current strategies are designed to methylate these cells to deactivate and "normalise" them again. miRs are about 20 nucleotide long smallRNAs acting to destroy specific mRNA. In the race to identify specific miRs as novel targets we have identified for example, that interleukin-6 modulates the expression of the Bone Morphogenic Protein Receptor Type II through a novel STAT3microRNA cluster 17/92 pathway, which helps to explain the loss of the BMPR2 in the vascular cells in pulmonary hypertension [3]. Moreover, miR-203 is regulating the production of IL-6 [4]. Most interestingly, epigenetic therapy is also on the horizon [5]. References 1. Lefèvre S, et al: Synovial fibroblasts spread rheumatoid arthritis to unaffected joints.

AIM:This study aims to evaluate the efficacy of Methotrexate (MTX) alone and combined therapy with Etanercept (ETN) and Methotrexate in patients with active rheumatoid arthritis (RA).METHODS:In the randomised control study, conducted in the period from March 2014 until March 2016, we evaluated the efficacy of the treatment of patients with RA with MTX as monotherapy and combination treatment with MTX and ETN. In the Clinic of Rheumatology in Prishtina, 90 adult patients with RA were treated in combination with ETN (doses of 50 mg subcutaneously/weekly), with oral MTX (doses up to 20 mg weekly), and MTX alone (doses up to 20 mg weekly) during this period of two years. Clinical response was assessed using European League against Rheumatism (EULAR)/American College of Rheumatology (ACR) Criteria and the Disease Activity Score (DAS28). Radiographic changes were measured in the beginning and at the end of the study using Larsen’s method.RESULTS:Of the cohort groups of 90 patients, mean age of 55.63, 15 patients, (16.6 %) were treated with combined therapy (ETN plus MTX) and 75 patients (83.3%) with monotherapy (MTX). After two years of treatment the group with combined therapy resulted with improvement of acute phase reactants as erythrocyte sedimentation rate (ESR) for the first hour (41.1 vs. 10.3 mm/hour) and C - reactive protein (CRP) (40.8 vs. 6 mg/liter), and compared to the group treated with monotherapy, there were no significant changes (ESR: 45.7 vs 34.3 mm/hour; CRP: 48 vs 24 mg/liter). Before the treatment, the severity of the disease was high, wherein the group with combined therapy DAS28 was 5.32, compared to the monotherapy group whom DAS28 was 5.90. After 2 years of treatment, we had significant changes in the results of DAS28, wherein the group treated with ETN plus MTX DAS28 was 2.12 ± 0.15, while in the group of patients treated with MTX DAS28 were 3.75 ± 0.39 (t = 13.03; df = 58; p < 0.0001). The group with combined therapy showed no evidence of radiographic progression comparing to the group of patients with monotherapy.CONCLUSIONS:Based on our results achieved during 2 years we can conclude that ETN in combination with MTX reduced disease activity, slowed radiographic progression and improved clinical manifestations more effectively than MTX alone. No serious adverse events were noticed in the group with combination treatment.