The paper gives the data currently available in the literature on the impact of biological agents (BA) on bone mineral density, metabolism, and remodeling in rheumatoid arthritis (RA). These agents, by virtue of their high efficacy, are widely used to treat patients with RA. Since localized and generalized bone resorption and destruction play a prominent role in its pathogenesis, an investigation of the effect of BA on bone may be of essential interest. Activated osteoclastogenesis occurs because of an interaction between the immune and bone systems under the influence of different proinflammatory cytokines. The inhibition of the latter has been ascertained to not only reduce joint inflammation, but also to prevent localized and generalized osteoporosis. This review discusses the results of these trials and the issues of further investigations.

О р и г и н а л ь н ы е и с с л е д о в а н и я 1 ФГБНУ Научно-исследовательский институт ревматологии им. В.А. Насоновой, Москва, Россия; 2 Кафедра пропедевтики внутренних болезней ГБОУ ВПО «Кемеровская государственная медицинская академия» Минздрава России, Кемерово, Россия; 3 Кафедра пропедевтики ГБОУ ВПО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России,

Ревматоидный артрит (РА)-наиболее частое хроническое аутоиммунное воспалительное заболевание, характеризующееся развитием системного воспалительного по-ражения внутренних органов и хронического артрита (синовита) [1]. РА сопровождается возникновением остеокласт-ассоциированных эрозий субхондральной кости и периар-О р и г и н а л ь н ы е и с с л е д о в а н и я ФГБНУ Научноисследовательский институт ревматологии им. В.А. Насоновой,

No abstract

Background Erosive and destructive changes in joints of hand and foot, bone mineral density (BMD) decrease and vertebral deformation are more common in patients with rheumatoid arthritis (RA) than in population. The association between these events is poorly investigated. There is a few published literature with conflictive results, and no information on national researches. Objectives to acquire information and determine the association between erosive and destructive changes in joints of hand and foot, BMD in different skeleton segments and vertebral deformity in thorax and lumbar spine in patients with RA. Methods 66 women with RA aged 18-62 years were enrolled. Radiological assessment of disease progression was performed with Sharp/van der Heijde method. Radiomorphogenic analysis of vertebral deformities was performed with Genant method. BMD evaluation in the three skeleton segments: lumbar spine (L1-4), femoral neck (FN) and distal forearm (DF) was performed with dual X-ray energy absorptiometry. Results the mean age of enrolled patients was 51,6±9,6 years, mean duration of the disease was 13,2±9.1 years. Vertebral fractures were detected in 3(5%) of the patients, vertebral deformations – in 11(17%). Rheumatoid factor (RF) was positive in 54(82%) patient, negative – in 11(18%). Glucocorticoid therapy received 45(68%) patients. Depending on the X-ray grade of RA patients were divided in 3 age-comparable groups: grade 1-2 (group 1) - 24(36%) patients, grade 3 (group 2) - 19(29%) patients, grade 4 (group 3) – 23(35%) patients. The mean age in group 1 was 49.1±12.9 years, in group 2 - 51.5±6.3 years, in group 3 - 54.4±7.1 years. The duration of RA in group 3 was longer, than in 2 and 1 groups - 20.4±10.4 years, 11.7±5.9 years and 7.5±3.1 years respectively (p<0.001). It was established, that the RA X-ray grade of RA increase is accompanied by the decrease of the BMD in L1-L4 - 0.972±0.170 g\cm2 and 0.867±0.090 g\cm2 (p=0.014), in FN 0.725±0.120 g\cm2 and 0.614±0.110 g\cm2 (p=0.003) and in DF 0.505±0.110 g\cm2 и 0.426±0.110 g\cm2 (p=0.026) (patients from group 2 and 3 respectively) and the increase of the number of patients with vertebral fractures and deformations – 3(13%) cases in group 1, 4(21%) cases in group 2 and 7(30%) cases in group 3. The mean patient’s age with patients rearrangement according to number of erosions (0-30 erosions in 39(59%) patients, 31-70 erosions - 14(21%) patients, more than 70 erosions -13(20%) patients) was 49.4±10.7*years, 53.1±7.9*years and 56.6±5.4*years respectively (*p<0,05). The increase in number of erosions was accompanied by BMD decrease in all skeleton segments: in L1-L4 segments 0.923±0.160*g\cm2, 0.920±0.110g\cm2 and 0.838±0.090*g\cm2 respectively (*p=0.045), in FN - 0.736±0.110g\cm2, 0.669±0.090g\cm2 and 0.582±0.120g\cm2 respectively (p<0.005), in DF - 0.488±0.090g\cm2, 0.479±0.110g\cm2 and 0.382±0.070g\cm2 respectively (p<0.001). In addition, the decrease in thorax and lumbar vertebral deformity index (0.79±0.02 - 0.72±0.07, p<0.001 and 0,80±0,00 - 0,74±0,16 re...