Sarcopenia is a progressive and generalized loss of muscle mass and function with advancing age. 1,2) This geriatric syndrome is now considered an increasing public health issue worldwide. 3) Sarcopenia is associated with adverse health outcomes such as physical impairment, mobility limitations, increased fall risk, hospitalization, and mortality. 4) In the last decade, several sarcopenia definitions and proposals for diagnostic criteria have been published. Among these, the revised consensus criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2) appear to be the most promising. The EWGSOP2 considers sarcopenia to be present when a person presents with both low muscle strength and low muscle mass. Additionally, people with low physical performance are categorized as severely sarcopenic. 3) This condition can also impact patient quality of life. Since this aspect is not straightforward for clinical evaluation, the issue is less studied so far. The existing quality of life questionnaires, such as the Short Form 36 (SF-36) and EuroQoL 5-dimension (EQ-5D), are designed for use in a broad swath of health conditions and pa

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Relevance. It is known that the poly-articular variant of JIA is associated with significant articular and extra-articular damages with predominant lesions of small and medium joints with limitation of their function and the development of ankylosis, requiring surgical intervention in these patients. Objective. The aim of the study was to evaluate the risk factors of articular and extra-articular damages in adults with the poly-articular variant of the JIA and to work out a prognostic model for their development. Materials and methods. The study included 45 adult patients with poly-articular (RF+ and RF-) variant of the JIA. Retrospective analysis of medical records of patients with poly-articular variant of JIA was made, taking into account clinical manifestations in the onset of the disease, laboratory parameters and response to therapy. In adulthood, the integral index of articular (JADI-A) and extra-articular (JADI-E) damages was used to assess the long-term effects of JIA. Results. Unfavorable prognostic factors were revealed by method of binary logistic regression. Mathematical model for predicting the probability of long-term negative articular and extra-articular damages of poly-articular JIA was developed. Conclusions 1. The risk factors for the development of articular and extra-articular damages in adulthood in patients with a poly-articular variant of the JIA are female sex, the presence of lymphadenopathy and/or splenomegaly in childhood, the level of ESR during treatment in childhood, the activity of JADAS in childhood, the presence of symmetric arthritis in childhood, the RF positivity in the debut of the disease, the treatment with glucocorticoids, the cumulative dose of the DMARDs, and lack of therapy by DMARDs. 2. A prognostic model for the development of articular and extra-articular damages in adult patients with a poly-articular variant of the JIA is developed. This model is effective and allows determine the adverse course of the disease and can be the basis for personalized treatment for the prevention of the development of significant articular and extra-articular damages of JIA.

To assess the long-term effects of juvenile idiopathic arthritis in adulthood, unified diagnostic methods for articular and extra-articular lesions should be used which depend on the juvenile idiopathic arthritis variants, the disease activity and treatment.

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Relevance. The existence of associations between histocompatibility antigens and JIA variants has been proved. There is no consensus that the JIAs associated with HLA-B27 antigen are transformed in adulthood into other diseases for which it is necessary to revise the diagnosis, according to the adult classification of rheumatic diseases. Is this one process that began in childhood and continues into adulthood, and whether these two processes that begin in childhood and adulthood have common signs and differences? There is few data about the hallmarks of the disease and outcome in adulthood.   Objective. – To investigate the frequency of HLA-B27 detection in adult patients with a history of JIA and to evaluate the clinical features of the course of arthritis in adulthood and the long-term articular and extra-articular consequences of JIA. Materials and methods. A survey of 132 young adult patients with different variants of JIA in the history (70 women, 62 males), aged – 24,3±8,3 years; disease duration – 13,6±9,3 years. We evaluated body mass index, anamnestic data, visual analogue scale, C-reactive protein quantitatively, HLA-B27, rheumatoid factor (RF), IgG-antibody to cyclic citrulline peptide (anti-CCP) and antinuclear antibody (АNА). Long-term effects JIA assessed by joint indices (JADI-A) and extraarticular (JADI-E) damage. Disease activity in childhood and adulthood was assessed on a scale JADAS (Juvenile Arthritis Disease Activity Score) and DAS 28. For statistic analises we use the Statistica 6.0 software packages Copyright © StatSoft, Inc. 1984-2001. Results. HLA-B27 was found in 38 patients with JIA (28,8 %), including 95 % of patients with enthesitis-related arthritis, 28,1 % – with persistent oligooarthritis and 36,8 % of patients with extended oligoarthritis, 8,3 % – with RF-positive JIA and 10,5 % – with the systemic onset JIA. According adult classification 61,5 % of patients with positive HLA-B27 antigen in adulthood developed ankylosing spondilitis or undifferentiated spondiloarthritis, in 22,7 % – undifferentiated arthritis, 100 % – psoriatic arthritis and 31,8 % – remission of the disease. In the childhood in HLA-B27 (+) patients, symmetrical joint damage (20,5 %, p<0,0001), enthesitis (20,5 %, p<0,05), lesion of the joints of the hands (26,4 %, p<0,05), defeat of more than 3 peripheral joints (36,8 %, p <0,05) and longer morning stiffness (Ме 40 [20; 60] min, p<0,001) were observed more often, compared with adult age. In adulthood, pain in the spine was significantly more frequent (27,5 %, p<0,01), as well as sacroilitis (15,0 %, p<0,05) and oligoarthritis (45 %, p<0,01). Only 21 % HLA-B27-positive patients received NSAIDs, 26,3 % had one DMARD and NSAIDs, 31,6 % had more than one DMARDs, and 21,1 % had a combination of different DMARDs and biological therapy (BTs). In childhood 58,3 % of patients received glucocorticoids and in adulthood only 22,2 % of patients but this difference was not significant. 42,1 % of adults needed intensification of therapy, 26,3 % of patients required BT. The most significant joint damages (JADI-A) in adulthood were found in the anti-CCP/RF-positive patients (3,04±4,90), whereas HLA-B27- positive patients had the lowest rates of this index, that shows the development of less remote negative consequences. Extra-articular damages (JADI-E) were most pronounced in АNА-positive patients (1,31±1,49), compared with a more favorable course in the groups anti-CCP/RF- (0,38±0,70; p <0,05) and HLA-B27-positive (0,50±1,06; p <0,05) patients. Conclusion. Clinical manifestations of articular syndrome have certain age-related pecularities in HLA-B27-positive patients with JIA: symmetrical joint damage, enthesitis, lesion of the joints of the hands, affections of more than 3 peripheral joints, and more prolonged morning stiffness are observed in childhood but in adulthood, pain in the spine, sacroilitis and oligoarticular lesion are more common. The presence of HLA-B27 antigen in patients with JIA is associated with the development of a smaller number of long-range articular damage (JADI-A), compared to the anti-CCP/RF-positive group (p <0,05) and less of the remote extra-articular effects (JADI- E) compared with the group of ANA-positive patients (p <0,05) in an adulthood.

Relevance. The polyarticular variant of juvenile idiopathic arthritis (JIA) is a disease that begins in childhood and leads to joint damage and disability in adulthood with significant social losses. At 18, patients go under the supervision of adult rheumatologists, often accompanied by loss of control of the disease due to insufficient compliance from both the patient and the physician. Today, there is no documented process for the transfer of patients from childhood to adulthood in Ukraine. Therefore, creating an algorithm for managing such patients is an urgent task.The polyarticular variant of JIA is a disease that begins in childhood and leads to joint damage and disability in adulthood with significant social losses.  Objective of this study was to evaluate the clinical and laboratory status and to develop an algorithm for managing adult patients with polyarticular variant of JIA, depending on the detection of RF or/and A-CCP.  Materials and methods. The study included 168 adult patients from different regions of Ukraine who were diagnosed with JIA in childhood between 1984 and 2014 without severe comorbidities.  Inclusion criteria were: 16 to 60 years old;  duration of the disease more than 3 years;  the presence of documentary evidence of childhood diagnosis of JIA (ambulatory card, hospital records). Among patients with JIA were identified 53 patients with polyarticular variant, of whom 42 or 25% - with RF (-) polyarthritis and 11 or 6.5% - with RF (+) polyarthritis. The disease activity was evaluated by DAS28 and JADAS-10. The questionaries SF-36, HAQ, TAS-20, PHQ-9 were analyzed and remote articular JADI-A and extra-articular JADI-E damages were evaluated. Statistical studies were performed using IBM SPPS Statistics version 25.0.0.0 software, the results were considered to be reliable at 5% critical level (P <0.05).  Results. The negative correlation of JADI-A and the patient's physical well-being PCS (r = -0.27, p <0.05) and physical functioning (r = -0.24, p <  0.05), pain intensity (r = -0.24, p <0.05), general health (r = -0.24, p <0.05), vital activity (r = -0,  19, p <0,05), social functioning (r = -0,27, p <0,05), mental health (r = -0,22, p <0,05) according to SF-36. The severity of extra-articular damages JADI-E correlated with PCS (r = -0.22, p <0.05) and physical functioning (r = -0.28, g  <0.05), pain intensity (r = -0.20, p <0.05), general health (r = -0.23, p <0.05), and mental health (r =  -0.23, p <0.05), but also had a positive rcorrelation with HAM-A (r = 0.25, p <0.05), depression scale (r = 0.28, p <0,  05) and PHQ-9 (r = 0.28, p <0.05).  Significantly lower level of physical health was established in patients who requires prosthetics (p <0.001) compared to those who did not need prosthetics.  Conclusion. Based on the results obtained, algorithms for managing adult patients with JIA positive for RF or / and A-CCP were developed, depending on the detected articular and extra-articular damages and the need for prosthetics and the psychological status.

Introduction. The problem of cardiovascular morbidity and mortality remains an urgent issue of modern medicine, and arterial stiffness is its independent predictor. Lively discussions about the correct approach to the prevention and treatment of comorbid conditions – increased vascular stiffness as an influential factor of the cardiovascular events and decreased bone mineral density (osteoporosis), primarily arise against the background of the need and safety of calcium and vitamin D supplements. The purpose was to search for literature data as for possible common pathogenetic links in the progression of arterial stiffness and the development of osteoporosis in order to assess the safety of the use of drugs to prevent osteoporotic fractures. Results. Analysis of literature sourses had showed that possible osteogenic factors affecting arterial stiffness may be: secondary hyperparathyroidism, disbalance of the RANK/RANKL/OPG system, inhibition of vitamin K-dependent matrix proteins (Gla-protein), osteopontin, etc. Conclusions. Today, there are many hypotheses confirming the possible influence of osteogenic factors on vascular stiffness and arterial calcification. Therefore, the search for sensitive markers and the development of screening protocols for the patients with risk factors for both osteoporosis and vascular changes are extremely relevant. A special issue is the possibility of using monotherapy for these comorbid pathologies, which can safely and efficiently influence the prevention of complications – both low-energy osteoporotic fractures and cardiovascular catastrophes. This will be the focus of our further research.