Introduction. Decreased bone mineral density (BMD) and the development of osteoporosis are common and poorly understood complications of ankylosing spondylitis (AS). Increased bone turnover and high inflammatory activity are important in the pathophysiology of AS-associated osteoporosis, and markers of bone remodeling are valuable markers for detecting bone loss The aim of the study. To find out the features of the BMD state in men with AS, based on establishing the frequency and nature of BMD violations, determining the content of metabolic indicators of bone tissue synthesis and resorption, vitamin D in blood serum, as well as identifying reliable factors involved in its violations. Materials and methods. The research group consisted of 83 men with AS, with an average age of 40.7 ± 0.8 years and a disease duration of 8.7 ± 0.5 years. Disease activity was determined by the BASDAI, ASDAS-CRB index. Laboratory examination included determination of C-reactive protein (CRP) and markers of bone tissue metabolism and vitamin D. BMD was measured using dual-energy X-ray absorptiometry Results. In men with AS, osteoporosis is found in 33.7 % of people, osteopenic syndrome in 28.9 % of patients, and normal indicators of BMD in 37.4 % of patients. We showed that low bone mass was closely related to the total indicators of the activity of the inflammatory process according to ASDAS, BASDAI and CRP content. In particular, in the group of patients with a very high degree of activity, the share of people with osteoporosis was equal to 78.6 %, and was 1.8 times higher than in the group of patients with moderate activity of AS. Similar patterns were observed for the BASDAI activity index and the pro-inflammatory marker CRP. In men with AS, the processes of bone resorption prevail over the processes of biosynthesis of bone tissue, as indicated by the preserved concentration of synthesis markers (OC, PINP) and the increase of the bone resorption marker (NTx) in blood serum. In addition, in the group of patients with osteoporosis, a high content of NTx was found in every second patient, and the average concentration was 39.0 % higher than in the group with preserved BMD. Loss of bone mass is closely related to a deficiency of vitamin D. Thus, in the group of patients with osteoporosis, in addition to probably low levels of vitamin D, a high proportion of people (57.2 %) with a severe deficiency was found, the insufficient level was in 43% and the optimal level equal to only 29.0 % of people. Conclusions. Patients with AS have a high frequency (62.6 %) of a decrease in BMD, while OP occurs in every third patient. Loss of bone mass depends on the activity of the inflammatory process, high levels of bone resorption markers and vitamin D deficiency.
The aim: To study the peculiarities of bone mineral density in the Ukrainian population of women of different reproductive age with systemic lupus erythematosus and to evaluate its connection with traditional and specific (typical for systemic lupus erythematosus) risk factors. Materials and methods: A total of 91 women with systemic lupus erythematosus and 29 healthy individuals were examined. Along with the clinical study of the activity and severity of the disease, the serum levels of interleukin-6 were determined by the enzyme immunoassay. The peculiarities of bone mineral density were studied using dual-energy X-ray absorptiometry. The presence of fractures was evaluated by the X-ray method. Results: Patients with systemic lupus erythematosus frequently suffer from reduced bone mineral density. Reduced bone mineral density and the appearance of fragility fractures are associated with patients’ age, disease duration, damage index, inflammatory activity, and cumulative dose of glucocorticoids. Conclusions: Progressive reduced bone mineral density in patients with systemic lupus erythematosus occurs not only during the aging process of a woman, but is also associated with a number of systemic lupus erythematosus – related osteoporosis risk factors.
patients with primary APS, 54 patients with positive aPL serology not meeting clinical criteria for APS and 326 healthy controls adjusted by the month of vitamin D analysis. We considered 30 ng/ml and 10 ng/ml as the thresholds for vitamin D insufficiency and deficiency, respectively. Results: Median levels of vitamin D were similar in the three groups: 21 (range 5-69) in primary APS, in the aPL-positive group, and 21 (4-105) in controls. Overall, 53.9% of measurements were performed during the sunny season (April to September). Ten percent of patients with primary APS were males, versus 16% in the aPL serology group and 26% among healthy controls (p=0.007). Mean age was 46±15 in primary APS, 49±17 in the aPL-positive group and 53±10 in the control group (p<0.001). Regarding vitamin D insufficiency, 82% of APS patients had levels of vitamin D (<30 ng/ml) versus 70% and 72% of patients with aPL serology and controls, respectively (p=0.168). When analyzing the prevalence of vitamin D deficiency (<10 ng/ml), we found significant differences across the groups: 16.2% in patients with primary APS, 11.1% in patients with positive serology and only 4.9% in healthy controls (p=0.002). There was no significant association between insufficient levels of vitamin D and the presence of thrombotic or obstetric events. Nevertheless, we found a trend for the presence of more thrombotic events in patients with vitamin D deficiency (p=0.097). Regarding the immunological profile, we found no association between vitamin D and either the number of positive antibodies or their serological evolution. However, we found an association between insufficient levels of vitamin D and the presence of lupus anticoagulant (54.7% vs 18.2%, p=0.047) Conclusions: More than 80% of patients with primary APS have insufficient levels of vitamin D and 16% of them have very low levels of vitamin D. Primary APS patients show a higher frequency of vitamin D deficiency than healthy controls. Patients with vitamin D insufficiency have more commonly positivity for lupus anticoagulant.Background: Antiphospholipid syndrome (APS) is an autoimmune disease defined by the presence of antiphospholipid antibodies (aPL) and thrombosis and/or pregnancy morbidity. Although thrombotic and obstetric APS are considered the same disorder, there are pathogenetic and clinical differences between them. Objectives: To describe the epidemiological, clinical and immunological characteristics of a cohort of APS patients from a defined population and to study the differences between thrombotic, obstetric and mixed APS. Methods: Retrospective study including patients attending the rheumatology and the obstetric clinics of a tertiary facility in Northern Spain. All patients met APS classification criteria. Results: We included 84 patients with thrombotic APS, 76 with obstetric APS and 10 with mixed APS. Main demographical characteristics are showed in table. There were differences in the age of discovery a positive serology (46±15 yr in thrombotic APS, 36±8 yr in obstetric, and 36±14 ...
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