The combination of socially significant common chronic non-infectious diseases of internal organs, the interaction of their pathogenetic links quite often leads to the development of complications that affect the course of the main nosology. Among these tandems, chronic pancreatitis and hypertension are considered — calcium-dependent diseases, the comorbidity of which can affect the disturbances in calcium metabolism, thereby contributing to the formation of osteopenic conditions. A number of researchers have established that the development of diseases such as chronic pancreatitis and hypertension, and their complications (namely, osteoporosis) can be the result of the presence of candidate genes, the unfavorable polymorphism of which can provoke changes in the pathogenetic directions of the diseases course.

FEATURES OF BONE REMODELING IN TYPE 2 DIABETES, COMBINED WITH OSTEOARTHRITIS

Objective — to assess the degree of osteodeficiency and probability of osteoporotic fractures in patients with type 2 diabetes mellitus in the absence or presence of lactase deficiency. Materials and methods. All examined patients with type 2 diabetes mellitus were divided into 2 groups depending on the presence/absence of lactase deficiency. In addition to routine examination methods, specific methods were used for diagnosing lactase deficiency, assessing bone mineral density (using dual‑energy X‑ray absorptiometry) and bone quality (ultrasound densitometry), the state of bone remodelling (according to markers of bone resorption and formation), probability of osteoporotic fractures (using FRAX and QFracture calculators), dietary and lifestyle habits were also studied. Results. The changes have been revealed in both processes of bone remodelling — increased bone resorption and insufficient bone formation, and the activity of bone formation, which was the lowest in patients with lactase deficiency and type 2 diabetes mellitus. The results of X‑ray absorptiometry confirmed that osteoporosis was significantly more often in patients with type 2 diabetes mellitus in the presence of lactase deficiency. The use of ultrasonic densitometry confirmed the violation of bone tissue micro architectonics. The indicator of broadband ultrasound attenuation, which reflects the qualitative characteristics of bone tissue, was the lowest in patients with type 2 diabetes mellitus accompanied by lactase deficiency. The probability of osteoporotic fractures according to the results of the assessment with the online calculator FRAX® was higher than the average risk in both groups of patients. No significant difference was established in this indicator between these groups of patients in contrast to the risk calculated with the QFracture instrument — it was the highest in patients with lactase deficiency. Conclusions. The presence of lactase deficiency in patients with type 2 diabetes mellitus can be considered as a factor that contributes to the development of osteodeficiency, deterioration of the quality of bone tissue, imbalance in bone remodelling and an increase in the probability of osteoporotic fractures.

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.

Introduction. According to statistics, gout -the most common cause of arthritis in men older than 30 years. At present, the disease is considered not only as clinicians recurrent monoarthritis, but as a systemic disease with severe visceral manifestations. It is therefore timely diagnosis of gout and its visceral manifestations, early and appropriate treatment of the main nosology and related pathologies has clinical and social importance for these patients.The aim of our study was to investigate the features of primary gout against pathology of the gastrointestinal tract (GIT), depending on the level of serum uric acid (SUA).Materials and methods. 25 patients with gout complicated by GIT pathology were examined. The investigation of patients included general clinical and laboratory methods (including assessment of articular syndrome, SUA level by uricase method), radiographic (joint X-ray). According to history, we detailed the duration of gout (first of all specific joint syndrome), frequency (last 12 months) and duration of exacerbations, the number of affected joints and tophi in the course of the disease and at the time of inspection. The intensity of pain joint syndrome evaluated on a ten visual analogue scale (VAS). Gastrointestinal pathology was diagnosed according to the criteria relevant diagnostic nosology.Results. Patients had different clinical gout variants: asymptomatic hyperuricemia, intermittent gout, chronic gout. Tophi were found in 6 patients. SUA level varied in the range from 360 to 731 mmol/l. To investigate the influence of SUA on the course of gout and gastrointestinal pathology, patients were divided into 2 subgroups according to the degree of hyperuricemia: the first subgroup (12 patients) with hyperuricemia greater than 600 mmol/l, the second subgroup (13 people) with moderate hyperuricemia 360-600 mmol/l. The severity of the disease was caused by a large number of affected joints (minimum 3, maximum 10) and the number of inflamed joints at inspection (2 to 6), high frequency of exacerbations joint syndrome during the year (min -2, max -8 times a year), duration last exacerbation (4-10 days). Localization arthritis was the following: the first metatarsus-phalangeal joints, ankle, knee and elbow joints, small joints of hands. The painful articular syndrome patients assessed with VAS scale from 5 to 10 points.Radiographic changes in affected joints were presented as following: the moderate local osteoporosis, vacuolelike bone defects with a rim of sclerosis; small erosion on the articular surfaces; consolidations and thickening of soft tissue, calcifications in soft tissues, signs of secondary osteoarthritis. These features correspond to the simultaneous exi stence of phenomena of degradation, degeneration and regeneration. The phenomena of osteoporosis were discovered in patients with chronic gout, while as erosive changes detected at high hyperuricemia and tophi gout.Pathology of the digestive tract was presented by gastroesophageal reflux disease with esophagitis (24.0 %) and without...