INDICATORS OF BONE METABOLISM IN PATIENTS WITH RHEUMATOID ARTHRITIS WITH IMPAIRED BONE MINERAL DENSITY: CHARACTERISTICS, THEIR FEATURES AND DIAGNOSTIC VALUE.

Rheumatoid arthritis (RA) is an autoimmune disease with a chronic inflammatory process that affects bone metabolism and leading to impaired bone mineral density (BMD). Therefore, the determination of laboratory markers of bone metabolism contributes to a better understanding of the pathogenesis of metabolic bone diseases. The aim of the study - to characterize the bone metabolism parameters in rheumatoid arthritis patients with impaired bone mineral density, to find out their features and diagnostic value. The study included 76 patients randomly stratified by RA status who were treated in the Rheumatology Department of Lviv Regional Clinical Hospital, a municipal non-profit enterprise of Lviv Regional Council, from 2013 to 2019. The goal was achieved by performing three consecutive stages of the study. At the first stage, markers of bone formation and bone resorption were characterized. At the second stage, the peculiarities of these indicators were determined. The third stage was to determine the diagnostic value of the content of the markers of OCN formation, P1NP and resorption marker ß-CrossLaps. According to the results of the study at the first stage, it was found that, in RA patients with osteopenia, the serum content of markers of osteoblastic bone function OCN (p=0.000) and P1NP (p=0.035) was significantly lower compared to the healthy individuals of CG, while the content of the marker of bone resorption ß-CrossLaps was significantly higher (p=0. 021); in RA patients with OP, the serum content of both markers of osteoblastic bone function OCN (p=0.000) and P1NP (p=0.001) is significantly lower, while ß-CrossLaps (p>0.050) is only slightly higher compared to healthy CG subjects. According to the results obtained at the second stage of the study, it can be stated that the content of OCN and P1NP in the blood serum is significantly lower in RA patients both with osteopenia and OP compared to RA patients without BMD disorders. At the third stage of the study, it was found significant relationship between the content of P1NP and belonging to SG1 (AC -0.52). A confirmed relationship was found between the content of OCN and belonging to the group with OP (direct direction of AC 0.57; p=0.017). Bone structure disorders in rheumatoid arthritis patients with osteopenia are characterized by a weakening of bone formation and increased resorption processes; in rheumatoid arthritis patients with osteoporosis, the weakening of osteoblastic bone function is more pronounced compared to rheumatoid arthritis patients with osteopenia. For rheumatoid arthritis patients with unimpaired bone mineral density, the highest diagnostic value is provided by procollagen type I N-terminal propeptide. For rheumatoid arthritis patients with osteoporosis, osteocalcin is a diagnostically valuable marker.

INFECTIOUSNESS OF SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS WITH CYTOMEGALOVIRUS AND EPSTEIN-BARR VIRUS.

Systemic lupus erythematosus (SLE) is an autoimmune disease caused by many polyclonal autoantibodies and characterized by numerous comorbid lesions of internal organs and systems. Research with respect to the role of various infectious agents in the development and course of SLE, and primarily the role of cytomegalovirus (CMV) and Epstein-Barr virus (EBV), is ongoing. It is important to find out whether patients with SLE are infected with CMV and EBV, since the clinical manifestations of SLE and active viral infection are similar. Aim - to find out the infection of SLE patients with CMV and EBV. The study included 115 patients with SLE, among whom women of working age predominated. The study was conducted in three stages: to find out CMV infection, to detect EBV infection, to determine the simultaneous infection of SLE patients with CMV and EBV and, in particular, their active phases. The actual material was processed on a personal computer in Excel (Microsoft) and IBM SPSS Statistics using descriptive statistics. It was found that the serum of the vast majority of SLE patients has specific antibodies to CMV, and only three have no antibodies to the virus. IgM antibodies to CMV were detected in 22.61% of patients, which may indicate an active phase of infection. Most often, the CMV seroprofile was detected as a combination of IgG (+) and IgM (-) (74.78%) among patients with SLE. It was established that the absolute majority of SLE patients are infected with EBV (98.26%). Active EBV infection was found in 15.65% of SLE patients, and chronic persistent - in 53.91%. Most often (53.91%) there are SLE patients with a seroprofile in the combination of EBV IgG to NA (+) IgG to EA (+) VCA IgM (-). Most often (41.74%) SLE patients had a combination of laboratory markers of viral infection in the form of seroprofile CMV IgG (+) IgM (-); EBV IgG to EA (+) IgG to NA (+) IgM to VCA (-). The active phase of CMV and/or EBV infection was present in 32.17% of SLE patients, of which: 16.52% had only active CMV infection, 9.57% - only active EBV infection, and 6.09% - a combination of active CMV and EBV infections, which indicates that more than a third of SLE patients have active CMV and/or EBV infections, which can affect the clinical manifestations of the disease and require specific treatment tactics. Almost all patients with SLE are infected with CMV, among whom 22.61% of patients have active infection. The absolute majority of SLE patients are infected with EBV, of which 15.65% had an active infection. Most often, SLE patients had a combination of laboratory markers of infection in the form of seroprofile CMV IgG (+) IgM (-); EBV IgG to EA (+) IgG to NA (+) IgM to VCA (-). The active phase of CMV and/or EBV infection was present in 32.17% of patients with SLE, of which: 16.52% had only active CMV infection, 9.57% only active EBV infection, and 6.09% - a combination of active CMV and EBV infections.

BONE MINERAL DENSITY AND THE PREVALENCE OF ITS DISORDERS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND SYNTROPIC COMORBID LESIONS.

The state of bone mineral density has not been properly examined yet in patients with systemic lupus erythematosus (SLE) and the pathogenetically associated syntropic comorbid lesions of organs and systems. In a randomized manner, after stratification by the presence of SLE, we enrolled 123 premenopausal women aged 21 to 51 years into the study. Patients with SLE, depending on the diagnosed pathogenetically associated syntropic comorbid lesions of organs and systems, were stratified into twenty groups (with hemorrhagic vasculitis, capillaritis, Raynaud syndrome, atherosclerosis, livedo reticularis, venous thrombosis, myocarditis, secondary hypertension, stable angina, pneumonitis, pneumosclerosis, autoimmune hepatitis, steatohepatitis, chronic pancreatitis, aseptic bone necrosis, arthralgia, myalgia, autoimmune thyroiditis, obesity, and alopecia). The bone mineral density (BMD) was determined for patients in each group through dual-energy X-ray absorptiometry (DXA) scans of the lumbar spine and proximal femur, taking into account the worst T-score result. Having analyzed the data from densitometric examinations of 20 patient groups, we arrived at the following conclusions: a) all patients from seven groups (with hemorrhagic vasculitis, capillaritis, stable angina, autoimmune hepatitis, steatohepatitis, aseptic bone necrosis, autoimmune thyroiditis) had reduced BMD disorders, and the largest proportion of patients with normal BMD were from the group with syntropic venous thrombosis; b) there was only one group of patients (with stable angina) without the cases of the first degree osteopenia, and the largest proportion of such patients was in the group with syntropic venous thrombosis; c) there was only one group of patients (with aseptic bone necrosis) without the cases of the second degree osteopenia, and the largest proportion of such patients was in the group with stable angina; d) there were patients with the third degree osteopenia in all groups, and the largest proportion of the third degree osteopenia cases was in the group with stable angina; e) there were no cases of osteoporosis in groups with syntropic venous thrombosis and stable angina, and the largest proportion of osteoporosis cases was in the groups with syntropic autoimmune hepatitis; the prevalence of osteoporosis is significantly higher than the prevalence of normal BMD and the first degree osteopenia in patients with atherosclerosis and chronic pancreatitis; the prevalence of osteoporosis is also significantly higher that the prevalence of normal BMD and all degrees of osteopenia in patients with autoimmune hepatitis.

THE PECULIARITIES OF AVERAGE VALUES OF THE INDICES OF NON-VIRUS LABORATORY MARKERS OF ACTIVE EPSTEIN-BARR VIRUS INFECTION IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS.

Epstein Barr Virus (EBV) originates from the subgroup of herpes viruses which have infected more than 90,0 % of adults worldwide. A special importance is attached to its affection of the patients with Systemic Lupus Erythematosus (SLE). We still have not found out which indices of active virus infection for SLE patients are the most productive and informative. We have involved 120 patients with the diagnosis of SLE. The results of the evaluation of changes in blood parameters indicate that in patients with active EBV infection the average hemoglobin content is significantly lower, and the average number of monocytes, the average content of AlT, C-RP, total protein and γ-globulins is significantly higher than in patients without active EBV infection. There are also significantly higher values of anti-dsDNA and ANA in patients in the experimental group and a lower average value of the total complement, which may indicate a negative effect of the active virus on the immune system in patients with SLE. The patients with SLE with active EBV infection have the features of the average values of non-viral laboratory markers which are reliably higher than for those infected without active virus replication and they are the indices of hyperalaninamino- transferaseemia, the content of C-reactive protein, of the average caption of antibodies to double-stranded deoxyribonucleic acid and the caption of antinuclear antibodies; the average values of the indices of average content of hemoglobin are also reliably lower as well as the index of a total complement. The regularities of changes of the indices of the conducted research discovered in the process of our research allow us to suspect active EBV Infection for the patients with SLE. The ultimate verification of this needs the application of direct serological tests.

ANALYSIS OF THE INDEXES OF CALCIUM AND PHOSPHORUS EXCHANGE, THE MARKERS OF THEIR REGULATION AND INDEX OF THE ACTIVITY OF SYSTEMIC LUPUS ERYTHEMATOSUS.

In the article we have analyzed the interrelations of the indexes of calcium and phosphor exchange, the markers of their regulation and the indexes of Systemic Lupus Erythematous activity. As a result of an examination of 123 premenopausal women with systemic lupus erythematosus and 25 mostly healthy women at premenopausal status of a relative age it was established that: according to the average values, the indexes of total calcium, ionized calcium, phosphor in the blood, phosphor in the daily urine, parathormone for the patients with Systemic Lupus Erythematous and healthy people did not differ. The content of calcium in the urine was authentically higher, while the content of vitamin D for the patients with Systemic Lupus Erythematous was lower in comparison to the healthy ones. There is a direct authentic connection between the content of calcium in urine and the activity index by SLEDAI that is why it is possible to claim that in case of the decrease of the illness activity the excretion of calcium in kidneys increases. A total index of activity by SLEDAI intercorrelates with the content of vitamin D in blood serum, namely the rise of activity by SLEDAI leads to the decrease of the vitamin D content in the blood serum.