Context. The prevalence and incidence of systemic lupus erythematosus (SLE) in the world is significant. In recent years, there has been a tendency of the SLE prevalence increase. despite the undoubted progress in understanding the etiology and pathogenesis of SLE, its diagnosis and treatment, the mortality of patients, including ones at young and working age, is higher than in the general population, and circulatory system lesions are ones of its main reasons in these cases. Objective. To analyze the literature, dedicated to the modern view on the problem of systemic lupus erythematosus with and without comorbid lesions of the circulatory system, describe the clinical case. Materials and methods. Content analysis, method of system and comparative analysis, bibliosemantic method of studying the current scientific investigations on modern principles of diagnosis and treatment of patients with SLE are used. A clinical case is described. Results. The article presents modern ideas about the etiological factors and pathogenesis of the disease. The clinical manifestations of SLE are very diverse. The problem of comorbidity and syntropy of lesions is relevant. Lesions of the cardiovascular system in the case of SLE can manifest itself in the form of pericarditis, myocarditis, endocarditis, lesions of the heart valves, coronary arteries, aorta, conduction system, pulmonary hypertension occurrence. The basic principles of drug therapy are also briefly considered. Conclusions. The results of the literature review indicate the importance of the problem of systemic lupus erythematosus, due to its widespread prevalence among the young and people of working age, lack of accurate knowledge about the etiology and pathogenesis of the disease, comorbid lesions of many organs and systems, including circulatory system, the development of severe and often life-threatening manifestations, the lack of clear recommendations that would predict the differentiated use of drugs taking into account comorbid syntropic lesions, which is also demonstrated in the described clinical case. Given this, systemic lupus erythematosus needs further in-depth study.
Introduction The prevalence rate of the digestive system lesions in patients with systemic lupus erythematosus (SLE) ranges from 8.0 to 50.0%. The symptoms caused by systemic lupus erythematosus (immunocomplex inflammation, vasculitis, etc.) have not been clearly distinguished yet from those that are associated with co-occurring diseases or adverse effects of medications used to treat patients with SLE. Objective To characterize and clarify the prevalence of the digestive system lesions that are pathogenetically associated with systemic lupus erythematosus. Materials and methods 370 patients (331 women and 39 men), stratified by age, duration, and activity of SLE, were included in the study and subjected to comprehensive examinations. The results were processed in Microsoft Excel using descriptive statistics, χ2 test, z-test for comparisons between two proportions; the relationship was considered to be statistically significant when p < 0.05. Results The digestive system lesions were detected in 225 (60.81%) patients with systemic lupus erythematosus. The prevalence of steatohepatitis, autoimmune hepatitis, and chronic pancreatitis rose with the progression of the underlying disease, so we concluded that they may be considered to be pathogenetically associated with systemic lupus erythematosus as syntropic comorbid lesions. Other digestive system lesions – chronic pharyngitis, cardiochalasia, gastroesophageal reflux disease, esophagitis, chronic gastritis, peptic ulcer, chronic duodenitis, duodenogastric reflux, duodenal ulcer, chronic viral hepatitis B, chronic viral hepatitis C, toxic hepatitis, liver cirrhosis, acalculous cholecystitis, chronic cholecystitis (asymptomatic gallstones, chronic calculous cholecystitis, gallbladder polyps), irritable bowel syndrome, chronic colitis, hemorrhoids, dolichosigma, peritoneal adhesions – are only comorbidities, ie. co-occurring digestive system lesions, since there was no relationship between their prevalence and the progression of the underlying disease. The mesenchymal inflammatory syndrome was detected in most patients with systemic lupus erythematosus and pathogenetically associated syntropic comorbid steatohepatitis. Hepatocellular dysfunction syndrome was detected in the three-fourths of patients with SLE and steatohepatitis. The mesenchymal inflammatory syndrome was also detected in all patients with SLE and pathogenetically associated syntropic comorbid autoimmune hepatitis. More than half of the patients with SLE and autoimmune hepatitis were also diagnosed with hepatocellular dysfunction and hepatic cytolysis syndromes. The asthenic-neurotic clinical syndrome occurred in the three-fourths of patients with SLE and pathogenetically associated syntropic comorbid chronic pancreatitis. Almost every second patient with SLE and chronic pancreatitis had a dyspeptic syndrome. Steatohepatitis was detected predominantly in patients aged 25 to 59 (young age subgroup II and middle age group). It was not detected in patients with the SLE duration of less than one year. Autoimmune hepatitis was detected predominantly in elderly patients and patients with the SLE duration of more than ten years. Chronic pancreatitis was significantly less prevalent in women and more prevalent in elderly patients – it occurred in almost half of them. It was absent in patients with the SLE duration of less than one year. Patients with the SLE duration of 6-10 years had the highest prevalence of chronic pancreatitis.
Introduction. Patients with rheumatoid arthritis (RA) are twice as likely to have osteoporosis (OP) compared to the general population. The strength of bones depends on mineral substances, mainly represented by calcium phosphate microcrystals. The chief role in the regulation of calcium-phosphorus metabolism is played by vitamin D and parathormone (PTH). The aim of the study. To investigate markers of calcium-phosphorus metabolism in patients with rheumatoid arthritis accompanied by bone mineral density (BMD) disorders and to find out their diagnostic value. Materials and methods. 76 patients with RA (64 premenopausal women and 12 mature men) were included in the study. All patients with RA were subjected to ultrasound bone densitometry and according to its results, patients were divided into three groups: patients with RA and osteopenia, patients with RA and OP; RA patients without BMD disorders. The control group included 22 healthy individuals of both genders without BMD abnormalities. To evaluate calcium-phosphorus metabolism, ionized calcium, total calcium, phosphorus, PTH, and vitamin D in blood serum, and levels of calcium and phosphorus in urine were detected. Results. It was revealed that concentration of total calcium in blood serum of patients with RA is lower compared to healthy individuals, while the same index in urine of patients with RA accompanied by osteopenia, OP or without BMD disorders is higher compared to healthy people. The concentration of vitamin D is significantly lower in patients with RA and OP compared to patients with RA with osteopenia, without BMD disorders, or healthy individuals. The concentration of PTH is higher in healthy individuals compared to patients with RA without BMD abnormalities or with osteopenia. Conclusions. In patients with rheumatoid arthritis with osteopenia or osteoporosis, significantly more often than in patients with rheumatoid arthritis without a violation of bone mineral density, ionized and total calcium, phosphorus in serum and urine, as well as vitamin D indices have deviations from the reference values and are of diagnostic significance.
Introduction. Systemic lupus erythematosus (SLE) is a disease with numerous clinical manifestations and an unpredictable course. It often lasts for several months or years, with alternating remissions and exacerbations. Multiple organs can be affected simultaneously with varying degrees of severity, resulting in treatment- and disease-related comorbidities, including circulatory system diseases, which are one of the leading causes of death of SLE patients. The aim of the study. To find out the nature and frequency of the circulatory system organs comorbid lesions in patients with systemic lupus erythematosus, to characterize them depending on the gender, age and the disease duration. Materials and methods. Prior to performing the study all patients signed the voluntary consent to participate in accordance with the requirements of Helsinki Declaration of Human Rights, the Council of Europe Convention on Human Rights and Biomedicine. The cohort under investigation included 112 patients with diagnosed SLE of different severity with preliminary stratification as follows: females 89.29 %, patients of working age (57.14 % – young and 39.29 % – middle aged), unemployed (58.04 %), III disability group patients (45.54 %), city residents (62.50 %). According to the results of the disease duration assessment, a significant number of patients with SLE and circulatory system organs comorbid lesions have been ill for 1–5 years (36.61 %) and more than 10 years (38.39 %). All of them were patients of the rheumatology department of the Communal Non-Profit Enterprise of the Lviv Regional Council “Lviv Regional Clinical Hospital” from 2016 to 2021.The research was carried out in several stages, during which the nature and frequency of the circulatory system comorbid lesions with respect to gender, age and disease duration were estimated. Results. While completing the study, almost half of patients with SLE were diagnosed with Raynaud’s syndrome, mitral valve insufficiency and atherosclerosis, about 1/3 – with myocarditis, retinal angiopathy, symptomatic arterial hypertension and livedo reticularis. The varicose veins of the lower extremities, hypertensive disease, diffuse cardiosclerosis, tricuspid valve insufficiency, vein thrombosis, post-thrombophlebitis syndrome, aortic valve insufficiency, capillaritis, pulmonary hypertension, coronary artery disease (CAD) including stable angina pectoris, cardiomyopathy and post-infarction cardiosclerosis were found with the decreasing frequency. Raynaud’s syndrome was significantly more often diagnosed in females and young people; retinal angiopathy, livedo reticularis and symptomatic arterial hypertension – in females and those patients whose SLE lasted for more than 10 years; myocarditis, varicose veins of the lower extremities – in males; capillaritis – in patients with the shortest duration of SLE; atherosclerosis and mitral valve insufficiency – in elderly patients and patients with SLE lasting for 6–10 years; vein thrombosis and stable angina – in elderly patients and those with SLE lasting for more than 10 years; hypertensive disease, diffuse cardiosclerosis, aortic valve insufficiency, post-infarction cardiosclerosis were the most characteristic for the elderly patients with SLE. Conclusions. In patients with systemic lupus erythematosus, a number of circulatory system organs comorbid lesions were found. Having studied their nature and frequency, characterizing them depending on gender, age and the disease duration, we found out the certain features that should be taken into consideration during the screening examination of circulatory system disorders in patients with systemic lupus erythematosus and providing them the integrated care to improve their life quality. With this in mind, systemic lupus erythematosus requires further detailed study.
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