porozendoОстеопороз и остеопатииOsteoporosis and Bone Diseases2072-26802311-0716Endocrinology Research Centre10.14341/osteo2011314-18porozendo-4053Research ArticleСтатьиArticlesИЗМЕНЕНИЯ МИНЕРАЛЬНОЙ ПЛОТНОСТИ КОСТНОЙ ТКАНИ У БОЛЬНЫХ АНКИЛОЗИРУЮЩИМ СПОНДИЛОАРТРИТОМIZMENENIYa MINERAL'NOY PLOTNOSTI KOSTNOY TKANI U BOL'NYKh ANKILOZIRUYuShchIM SPONDILOARTRITOMMYaSOUTOVAL. I.

assistent kafedry gospital'noy terapii

-LAPShINAS. A.

k.m.n., assistent kafedry gospital'noy terapii

-SALIKhOVI. G.

zav. kafedroy gospital'noy terapii, professor, d.m.n., chlen-korrespondent AN RT, glavnyy revmatolog

-VASIL'EVA. G.

aspirant kafedry gospital'noy terapii

-201115122011143№3 (2011)1418Copyright © MYaSOUTOVA L.I., LAPShINA S.A., SALIKhOV I.G., VASIL'EV A.G., 20112011MYaSOUTOVA L.I., LAPShINA S.A., SALIKhOV I.G., VASIL'EV A.G.MYaSOUTOVA L.I., LAPShINA S.A., SALIKhOV I.G., VASIL'EV A.G.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.osteo-endojournals.ru/jour/article/view/4053

Цель исследования — определить характер изменений МПК у пациентов АС в зависимости от демографических данных, клинических и лабораторных показателей. Материалы и методы. Иа базе Центра профилактики и лечения остеопороза г Казани проведено исследование 42 пациентов с достоверным диагнозом АО. мужчин — 36 (85,7%), женщин — 6 (14,3%), в возрасте от 21 до 47 лет (средний возраст 33,2±8,4), с длительностью заболевания 7,8±5,9 лет. Все пациенты были позитивны по HLA В27, поражение периферических суставов наблюдалось у 23 (54,8%) человек. исследование включало в себя оценку боли в спине, утренней скованности, измерение экскурсии грудной клетки, тест Шобера, определение индексов BASDAI и BASFI, ASDAS-CRP, сОЭ, сРБ. Для оценки МПК всем пациентам проведена двухэнергетическая рентгеновская абсорбциометрия DХA) поясничного отдела позвоночника L 1-L 4) и проксимального отдела бедренной кости. Результаты. среди мужчин нормальная МПК выявлялась у 6 (16,7%) человек, остеопения — у 19 (52,8%), ОП — у 11 (30,5%) пациентов. среди женщин нормальная МПК определялась у 1 (16,7%) человека, остеопения также у 1 (16,7%), ОП — у 4 (66,6%) женщин. МПК в поясничном отделе позвоночника у мужчин была значительно ниже, чем у женщин (р<0,05). Пациенты с высокой лабораторной активностью и поражением периферических суставов имели достоверно более низкую МПК в поясничном отделе позвоночника. Пациенты с ОП и остеопенией имели более выраженный болевой синдром, чем пациенты с нормальной МПК. Выявлена корреляция МПК с длительностью Ас, тестом Шобера, активностью заболевания и уровнем сРБ. Выводы. Предикторами снижения МПК у пациентов с Ас являлись такие показатели, как высокая клиническая и лабораторная активность, периферический артрит, сниженный функциональный статус. Пациенты с ОП и остеопенией имели более выраженный болевой синдром.

Objective. To determine a bone mineral density (BMD) changes in patients with ankylosing spondylitis (AS) depending on demographical data, clinical and laboratory findings. Materials and methods. 42 patients (male - 36 (85,7%), female - 6 (14,3%), 21 to 47 years of age, mean age 33,2±8,4, mean disease duration 7,8±5,9 years) with proven diagnosis of AS were included in the study performed at the Centre of osteoporosis treatment and prevention. All patients were HLA-B27 positive, 23 (54,8%) had peripheral arthritis. Evaluation included back pain assessment with VAS scale, morning stiffness duration assessment, modified Schober’s test, limitation of chest expansion assessment, calculation of BASDAI, BASFI and ASDAS-CRP scores, ESR and CRP levels. To evaluate BMD all patient underwent dual-emission X-ray absorptiometry (DXA) at lumbar spine (L1-L4) and hip neck. Results. Among male patients normal BMD was found in 6 (16,7%) patients, 19 (52,8%) had osteopenia, 11 (30,5%) -osteoporosis. Among male patients normal BMD was found in 1 (16,7%) patients, 1 (16,7%) had osteopenia, 4 (66,6°%) — osteoporosis. BMD at the lumbar spine in male patients was significantly higher compared to females (p<0,05). Patients with high disease activity and peripheral arthritis had significantly lower BMD at lumbar spine. Patients with osteoporosis and osteopenia had higher pain score on VAS compared to patients with normal BMD. We observed an association between BMD and duration of AS, Schober’s test results, disease activity and CRP. Conclusion. High clinical activity, presence of peripheral arthritis, significant changes in spinal movement were found to be predictors of BMD decrease in patients with AS. Patients with AS and osteopenia had more pronounced pain syndrome.

анкилозирующий спондилоартритостеопорозостеопенияабсорбциометрияминеральная плотность костиankylosing spondylitisosteoporosisosteopeniaabsorptiometrybone mineral densityReferencesBraun, J. Building consensus on nomenclature and disease classification for ankylosing spondylitis: results and discussion of a questionnaire prepared for the international Workshop on New Treatment Strategies in Ankylosing Spondylitis, Berlin, Germany, 18-19 January 2002 / J. Braun, J. Sieper // Ann. Rheum. Dis. — 2002. — Vol.3. — P. 1161-1167.Braun, J. Building consensus on nomenclature and disease classification for ankylosing spondylitis: results and discussion of a questionnaire prepared for the international Workshop on New Treatment Strategies in Ankylosing Spondylitis, Berlin, Germany, 18-19 January 2002 / J. Braun, J. Sieper // Ann. Rheum. Dis. — 2002. — Vol.3. — P. 1161-1167.Braun J., Bollow M., Remlinger G., et al. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum. Jan 1998;41(1):58-67.Braun J., Bollow M., Remlinger G., et al. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum. Jan 1998;41(1):58-67.Braun J., Sieper J. Ankylosing spondylitis. Lancet. Apr 21 2007;369(9570):1379-90.Braun J., Sieper J. Ankylosing spondylitis. Lancet. Apr 21 2007;369(9570):1379-90.Gratacos J., Collado A., Pons F., et al.: Significant loss of bone mass in patients with early, active ankylosing spondylitis. A follow-up study. Arthritis Rheum 1999; 42: 2319-24.Gratacos J., Collado A., Pons F., et al.: Significant loss of bone mass in patients with early, active ankylosing spondylitis. A follow-up study. Arthritis Rheum 1999; 42: 2319-24.Crotti T.N., Smith M.D., Weedon H. et al. Receptor activator NF-kappaB ligand (RANKL) expression in synovial tissue from patients with rheumatoid arthritis, spondyloarthropathy, osteoarthritis, and from normal patients: semiquantitative and quantitative analysis. Ann Rheum Dis 2002;61:1047-54.Crotti T.N., Smith M.D., Weedon H. et al. Receptor activator NF-kappaB ligand (RANKL) expression in synovial tissue from patients with rheumatoid arthritis, spondyloarthropathy, osteoarthritis, and from normal patients: semiquantitative and quantitative analysis. Ann Rheum Dis 2002;61:1047-54.Lange U., Kluge A., Strunk J. Ankylosing spondylitis and bone mineral density — what is the ideal tool for measurement. Rheumatol Int 2005; 26: 115-20.Lange U., Kluge A., Strunk J. Ankylosing spondylitis and bone mineral density — what is the ideal tool for measurement. Rheumatol Int 2005; 26: 115-20.Bessant R., Keat A. (2002) How should clinicians manage osteoporosis in ankylosing spondylitis? J Rheumatol 29, 1511-9.Bessant R., Keat A. (2002) How should clinicians manage osteoporosis in ankylosing spondylitis? J Rheumatol 29, 1511-9.Meireless E.S., Borelli A., Camargo O.P. Influence of disease activity and chronicity on ankylosing spondylitis bone mass loss. clin Rheumatol 1999;18:364-8.Meireless E.S., Borelli A., Camargo O.P. Influence of disease activity and chronicity on ankylosing spondylitis bone mass loss. clin Rheumatol 1999;18:364-8.Sinigaglia L., Varenna M., Girasole G., Bianchi G. Epidemiology of osteoporosis in rheumatic diseases. Rheum Dis Clin North Am 2006; 32:631-658.Sinigaglia L., Varenna M., Girasole G., Bianchi G. Epidemiology of osteoporosis in rheumatic diseases. Rheum Dis Clin North Am 2006; 32:631-658.Ulusoy H., Bilgici A., Kuru O. et al. Relationship between bone mineral density and disease activity in patients with ankylosing spondylitis. Turk J Rheumatol 2010; 25: 24-8.Ulusoy H., Bilgici A., Kuru O. et al. Relationship between bone mineral density and disease activity in patients with ankylosing spondylitis. Turk J Rheumatol 2010; 25: 24-8.Donnelly S., Doyle D.V., Denton A., Rolfe I., McCloskey E.V., Spector T.D. Bone mineral density and vertebral compression fracture rates in ankylosing spondylitis. Ann Rheum Dis 1994; 53: 117-21.Donnelly S., Doyle D.V., Denton A., Rolfe I., McCloskey E.V., Spector T.D. Bone mineral density and vertebral compression fracture rates in ankylosing spondylitis. Ann Rheum Dis 1994; 53: 117-21.Lee Y.S., Schlotzhauer T., Ott S.M., van Vollenhoven R.F., Hunter J., Shapiro J., et al. Skeletal status of men with early and late ankylosing spondylitis. Am J Med 1997; 103: 203-41.Lee Y.S., Schlotzhauer T., Ott S.M., van Vollenhoven R.F., Hunter J., Shapiro J., et al. Skeletal status of men with early and late ankylosing spondylitis. Am J Med 1997; 103: 203-41.Ralston SH, Urquhart GDK, Brzeski M et al. Prevalence of vertebral compression fracture due to osteoporosis in ankylosing spondylitis. Br Med J 1990; 300:563-565.Ralston SH, Urquhart GDK, Brzeski M et al. Prevalence of vertebral compression fracture due to osteoporosis in ankylosing spondylitis. Br Med J 1990; 300:563-565.Braun J., Pincus T. — Mortality, course and prognosis of patients with ankylosing spondylitis. Clin Exp Rheumatol 2002; 20:S16-S22.Braun J., Pincus T. — Mortality, course and prognosis of patients with ankylosing spondylitis. Clin Exp Rheumatol 2002; 20:S16-S22.Jun J.B., Joo K.B., Her M.Y., et al. Femoral bone mineral density is associated with vertebral fractures in patients with ankylosing spondylitis: a cross-sectional study. J Rheumatol 2006; 33:1637-1641.Jun J.B., Joo K.B., Her M.Y., et al. Femoral bone mineral density is associated with vertebral fractures in patients with ankylosing spondylitis: a cross-sectional study. J Rheumatol 2006; 33:1637-1641.Maksymovych W.P., Jhangri G.S., Leclercq S., Skeith K., Yan A, Russell AS. An open study of pamidronate in the treatment of refractory ankylosing spondylitis. J Rheumatol 1998; 25: 714-7.Maksymovych W.P., Jhangri G.S., Leclercq S., Skeith K., Yan A, Russell AS. An open study of pamidronate in the treatment of refractory ankylosing spondylitis. J Rheumatol 1998; 25: 714-7.Allali F., Breban M., Procher R., Maillefert J.F., Dougados M., Roux C. Increase in bone mineral density of patients with spondyloarthropathy treated with anti-tumour necrosis factor. Ann Rheum Dis 2003; 63: 347-9.Allali F., Breban M., Procher R., Maillefert J.F., Dougados M., Roux C. Increase in bone mineral density of patients with spondyloarthropathy treated with anti-tumour necrosis factor. Ann Rheum Dis 2003; 63: 347-9.J. Sieper, M. Rudwaleit, X. Baraliakos et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 2009; 68(Suppl II):ii1-ii44.J. Sieper, M. Rudwaleit, X. Baraliakos et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 2009; 68(Suppl II):ii1-ii44.The world Health Organization (2007) Assessment of osteoporosis at the primary health care level — Summary report of a WHO Scientific Group. WHO, Geneva.The world Health Organization (2007) Assessment of osteoporosis at the primary health care level — Summary report of a WHO Scientific Group. WHO, Geneva.Binkley N., Bilezikian J.P., Kendler D.L., et al. (2007) Summary of the international society for clinical densitometry 2005 position development conference. J Bone Miner Res 22, 643.Binkley N., Bilezikian J.P., Kendler D.L., et al. (2007) Summary of the international society for clinical densitometry 2005 position development conference. J Bone Miner Res 22, 643.El. Maghraoui, Borderie D., Cherruau B., Edouard R., Dougados M., Roux C. Osteoporosis, body composition, and bone turnover in ankylosing spondylitis. J Rheumatol 1999; 26: 2205-9.El. Maghraoui, Borderie D., Cherruau B., Edouard R., Dougados M., Roux C. Osteoporosis, body composition, and bone turnover in ankylosing spondylitis. J Rheumatol 1999; 26: 2205-9.Speden D.J., Calin A.I., Ring F.J., Bhalla A.K. Bone mineral density, calcaneal ultrasound, and bone turnover markers in women with ankylosing spondylitis. J Rheumatol 2002; 29: 516-21.Speden D.J., Calin A.I., Ring F.J., Bhalla A.K. Bone mineral density, calcaneal ultrasound, and bone turnover markers in women with ankylosing spondylitis. J Rheumatol 2002; 29: 516-21.Capaci K., Hepguler S., Argin M., et al — Bone mineral density in mild and advanced ankylosing spondylitis. Yonsei Med J 2003; 44:379-384.Capaci K., Hepguler S., Argin M., et al — Bone mineral density in mild and advanced ankylosing spondylitis. Yonsei Med J 2003; 44:379-384.Mitra D., Elvins D.M., Speden D.J., et al — The prevalence of vertebral fractures in mild ankylosing spondylitis and their relationship to bone mineral density. Rheumatology 2000; 39:85-89.Mitra D., Elvins D.M., Speden D.J., et al — The prevalence of vertebral fractures in mild ankylosing spondylitis and their relationship to bone mineral density. Rheumatology 2000; 39:85-89.Toussirot E., Michel F., Wendling D. — Bone density, ultrasound measurements and body composition in early ankylosing spondylitis. Rheumatology 2001; 40: 882-888.Toussirot E., Michel F., Wendling D. — Bone density, ultrasound measurements and body composition in early ankylosing spondylitis. Rheumatology 2001; 40: 882-888.Wendling D. — Bone loss in ankylosing spondylitis: Can we put the puzzle together? J Rheumatol 2005; 32:1184-1186.Wendling D. — Bone loss in ankylosing spondylitis: Can we put the puzzle together? J Rheumatol 2005; 32:1184-1186.Dos Santos FP, Constantin A, Laroche M, et al — Whole body and regional bone mineral density in ankylosing spondylitis. J Rheumatol 2001; 28:547-549.Dos Santos FP, Constantin A, Laroche M, et al — Whole body and regional bone mineral density in ankylosing spondylitis. J Rheumatol 2001; 28:547-549.Maillefert JF, Aho LS, El Maghraoui A, et al — Changes in bone density in patients with ankylosing spondylitis: a two-year follow-up study. Osteoporos Int 2001; 12:605-609.Maillefert JF, Aho LS, El Maghraoui A, et al — Changes in bone density in patients with ankylosing spondylitis: a two-year follow-up study. Osteoporos Int 2001; 12:605-609.Lukas C, Landewe R, Sieper J, Dougados M, Davis J, Braun J, van der Linden S, van der Heijde D. Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis 2009;68:18-24.Lukas C, Landewe R, Sieper J, Dougados M, Davis J, Braun J, van der Linden S, van der Heijde D. Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis 2009;68:18-24.

The authors declare that there are no conflicts of interest present.