musculoskeletal disorders are an extremely common pathology. They are the most common cause of chronic pain and disability: every minute, more than 30% of adults suffer from joint pain or limited physical activity. These diseases significantly affect the psychosocial status of patients, their families, and caregivers. The course of joint diseases leads to loss of mobility, social autonomy; such patients have higher rates of hospitalization and mortality. That is, the quality of life significantly deteriorates, and the financial costs of health care for patients and society increase. It is proved that one of the predictors of arthrosis is overweight. In the pathogenesis of osteoarthritis and obesity, proinflammatory cytokines play an important role, the excess synthesis of which leads to the progression and chronicity of the process. Therefore, the aim of our study was to determine the dependence of interleukin-18 activity in patients with osteoarthritis, which occurs on the background of obesity and without it. The study presents the study of interleukin-18 in 75 people with osteoarthritis (OA), which occurred on the background of obesity (main group), and 50 patients with isolated OA (comparison group). The control group consisted of 37 healthy individuals. The diagnosis of OA was established based on the order of the Ministry of Health of Ukraine of 12.10.2006 "On medical care for patients with osteoarthritis", unified diagnostic criteria of the Association of Rheumatologists of Ukraine (2004), and the criteria of the American College of Rheumatologists. The presence and severity of obesity were assessed according to the criteria of the International Diabetes Federation (IDF, 2005) based on the calculation of body mass index (BMI) according to the Kettle formula. When determining the level of IL-18 in the main group, it was found that the content of this cytokine was almost two times higher than the reference values (p <0.05). In the comparison group, the activity of IL-18 increased 1.6 times (p <0.05). Comparison of the content of IL-18 between the study groups allowed us to determine its increase in the presence of obesity by almost 1.2 times. The increase in IL-18 content depended on the radiological stage of joint damage: the maximum value was recorded in patients of the main group with stage 2 symptoms. Apparently, such results are a consequence of the predominance of the inflammatory reaction in the progression of the pathology due to the comprehensive involvement of extra-articular components (ligaments, tendons, bags, etc.). Slightly lower levels of IL-18 in stage 1 OA are likely to be due to the involvement of a limited portion of joint tissue, while the 3rd radiological stage is characterized by a predominance of dystrophic processes. In patients with osteoarthritis, an increase in the content of IL-18 in the serum is determined, which is associated with the development of the inflammatory process in the components of the joint. The content of IL-18 has a direct correlation with overweight / obesity and the radiological stage of the process in the joints. Increased proinflammatory cytokine IL-18, which is a component of the immune system and simultaneously synthesized by adipocytes of adipose tissue, can be considered a factor that will contribute to the preservation of chronic pain and progression of the pathology. Dynamic control of IL-18 activity should be used as an indicator of the effectiveness of therapy.

The purpose of the study was to determine the content of osteoprotegerin in the blood serum of patients with osteoarthritis, based on the stage of obesity and the state of bone mineral density. Materials and methods. Under surveillance there were 75 patients with osteoarthritis, which proceeded against the background of an altered body mass index. The comparison group consisted of 50 patients with osteoarthritis and normal body weight. The age of patients in both groups was comparable, and gender balance was observed between groups. The osteoprotegerin index (pg/ml) was studied in fasting blood serum by enzyme immunoassay (ELISA) using of the FineTest EH0247 reagents, China. The prevalence of osteoporotic conditions was assessed using dual-energy x-ray absorptiometry (DEXA), HOLOGIC Explorer QDR W Series Bone Densitometer (USA). Statistical analysis was performed using the software package Statistics 10.0 and Excel 2010. Cardinal and ordinal changes were compared using the Mann-Whitney test. Correlation was calculated using Spearman's rank correlations. In all statistical analysis procedures, the level of significance p was taken equal to or less than 0.05 (p <0.05). Based on body mass index, all patients in the main group were divided into 3 subgroups. Thus, changes in body weight were recorded in 75 patients with osteoarthritis (main group). 1st stage of obesity was found in 31 patients (42%); 2nd – 22 patients (29%) and 22 patients (29%) with osteoarthritis were overweight. Results and discussion. When studying the content of osteoprotegerin in the examined patients, it was found that both in the isolated course of osteoarthritis (92.29±1.68 pg/ml) and in its combination with obesity (124.03±3.2 pg/ml), there was an increase in this indicator when compared with the results of patients in the control group (65.64±0.64, p <0.05). In order to study the state of bone mineral density in patients with osteoarthritis, a densitometric study was performed using double energy X-ray absorptiometry – DEHA (device "Expert 1188", Lunar, USA), which allowed to diagnose osteoporotic conditions. Thus, signs of osteopenia were found in 11 patients (15%) of the main and 8 people (16%) of the comparison group. Manifestations of osteoporosis were found in 18 (24%) and 5 people (10%), respectively. In patients of the main group with osteopenia, the content of osteoprotegerin in the blood serum corresponded to 108.43±0.48 pg/ml, in the comparison group – 84.86±0.87 pg/ml. With the development of osteoporosis, this value exceeded the control values, however, it was somewhat lower than with osteopenia: 99.94±1.1 and 73.57±1.66 pg/ml, respectively. Conclusion. The course of osteoarthritis is accompanied by an increase in the production of osteoprotegerin, which indicates a violation of bone tissue remodeling through increased processes of its resorption. The level of blood serum osteoprotegerin in patients with osteoarthritis has a significant increase with weight gain and its maximum value is observed in patients with 2nd stage of obesity. In patients with osteoarthritis, the formation of osteoporotic conditions (osteopenia or osteoporosis) is observed, one of the markers of which can be considered an increase in the content of osteoprotogerin glycoprotein – cytokine, which is characterized by inhibition of osteoclast production

SUMMARY. Osteoarthritis (OA) leads to the degeneration of the articular cartilage, and as a cause of disability it ranks first among the diseases of the musculoskeletal system. Currently, a number of researchers believe that OA can be considered in the context of metabolic syndrome, one of the components of which is obesity. According to modern concepts, muscle tissue is one of the most important human endocrine organs, since it produces a large amount of biologically active substances, hormones and special cytokines (myokines). The latter are cellular regulators of growth and degradation, and support the function of muscle mitochondria. Thus, in the course and progression of OA in patients with increased body weight and obesity, two endocrine-dependent organs "compete" – adipose and muscle tissues. In this case, we should expect not a potentiation of their impact, but a new qualitative effect. And this result of the combined course can be considered the formation of secondary osteoporosis. The aim – to optimize the diagnosis of osteopenic conditions in young people with osteoarthritis occurring against the background of overweight/obesity by determining the role of osteoprotegerin in the formation of complications. Materials and Methods. The research included the evaluation of osteoprotegerin values in 75 people with osteoarthritis (OA) proceeding against the background of obesity (main group), and 50 patients with isolated OA (comparison group). The control group consisted of 37 apparently healthy individuals. The diagnosis of OA was established based on the order of the Ministry of Health of Ukraine dated 10/12/2006 "On the provision of medical care to patients with osteoarthritis", the unified diagnostic criteria of the Association of Rheumatologists of Ukraine (2004) and the criteria of the American College of Rheumatology. The presence and severity of obesity was assessed according to the criteria of the International Diabetes Federation (IDF, 2005) based on the calculation of the body mass index (BMI) according to the Quetelet index. Results. When calculating the content of osteoprotegerin (OCG) it was found that in both examined groups this value exceeded the control values: 1.9 times in patients of the main group and 1.4 times in the comparison group. When the BMI changes in all groups of subjects, there was a significant increase in the OCG relative to control indicators. It was also found that the development and course of osteoarthritis in patients with overweight or obesity occurs against the background of increased serum osteoprotegerin. Conclusions. The course of osteoarthritis is accompanied by a significant increase of serum osteprotegerin, the level of which increases with increasing body weight. Serum osteoprotegerin indicator correlates with the radiological stage of the disease and has a maximum value at third stage of the disease. The presence of OA in obese patients is an unfavorable background for the formation of osteoporotic conditions, one of the mechanisms of which is an increase in serum osteprotegerin, a glycoprotein with an apoptotic effect at the level of osteoclasts.

In 125 patients with osteoarthritis (OA), among whom 75 had increased body weight, the content of matrix metalloproteinase-9 (MMP-9) was studied. It was established that the course of OA is accompanied by an increase in the content of MMP-9, which correlates with the body mass index. It was proved that the activity of this enzyme did not depend on gender and age in young patients, but had a direct correlative dependence on the radiological stage of the disease. It is recommended to use this enzyme as an additional criterion for the course of osteoarthritis and control of treatment measures.

According to statistics provided by the World Health Organization, in 2020 there will be about 2 billion adults, 41 million children under the age of 5 and 340 million children and adolescents aged 5 to 19 who are obese. It is proved that quite often obesity is a predictor of the formation of diseases of the musculoskeletal system. The purpose of the study was to determine the state of lipid and carbohydrate metabolism in patients with different stages of obesity and to establish their influence on the course of osteoarthritis. Materials and methods. The study involved 75 patients with osteoarthritis, which proceed on the background of obesity (main group). 50 patients had manifestations of osteoarthritis without changes in body mass index and 37 almost healthy individuals were included in the control group. Anthropometric data and body mass index were calculated. The state of lipid metabolism was determined by indicators of total cholesterol, triglycerides, high, low and very low density lipoproteins, atherogenic factor. The rate of carbohydrate metabolism was assessed by the presence of insulin resistance by calculating the Homeostasis Model Assessment of Insulin Resistance index. Body mass index was calculated by the Kettle formula. Other anthropometric parameters were determined by measuring the volume of the thigh, waist volume and calculated the ratio of volume of the thigh to waist volume. As markers of lipid metabolism we studied the content of total cholesterol, triglycerides, high-density lipoproteins, low-density lipoproteins and very low-density lipoproteins in the blood system with peroxide. The atherogenicity index was determined by the formula of Klimov A. M. Statistical analysis was performed using the software package "Statistica 10.0" and Excel 2010. To quantify the results, the results were presented as the median with a quarterly interval [Q25%; Q75%] taking into account the lack of normal distribution. Quantitative and ordinal changes were compared using the Mann-Whitney test. The correlation was calculated using Spearman's rank correlations. In all procedures of statistical analysis, the significance level p was assumed to be equal to or less than 0.05 (p <0.05). Results and discussion. We divided the patients of the main group into subgroups depending on the body mass index: overweight patients with I and II obesity degree. The comparative analysis of indicators of lipid metabolism allowed to establish increase of indicators of all atherogenic classes in comparison with control. A statistically significant difference in the rate of total cholesterol was determined only in the case of its comparison between the group with elevated body weight and I degree of obesity. Conclusion. In patients with osteoarthritis, occurring on the background of overweight or obesity, there are shifts in lipid and carbohydrate metabolism, which contribute to metabolic disorders in the body and, in particular, cartilage as a type of connective tissue. Patients with isolated osteoarthritis also have hyperlipidemia and in some cases insulin resistance, which is a negative basis for the progression of the pathological process. One of the factors in the progression of osteoarthritis in obese patients can be considered the activation of free radical oxidation of lipids, which occurs both as a result of osteoarthritis and the presence of concomitant pathology