Цель исследования -оценить состояние системы регуляции остеокластогенеза -остеопротегерин/лиганд рецептора активатора нуклеарного фактора κβ (OPG/RANKL) -у мужчин с различными клиническими вариантами анкилозирующего спондилита (АС).Материал и методы. Система регуляции остеокластогенеза изучалась у 60 мужчин: 40 больных с диагнозом АС, соответствую-щим модифицированным Нью-Йоркским критериям (1984 г.)
Methods:We reviewed the clinical records of MM patients diagnosed at a single institution between 1970 and 2015. One thousand one hundred sixty-one patients (591 [50.9%] male; median age at diagnosis 64 years) was the final study population. Median follow-up for alive patients was 5.4 years (range, 0.5-34.4 years). Relative survival (RS) and disease-specific incidence mortality were calculated and expressed in incidence rate ratio (IRR). Long-term survival was defined as those who lived more than 10 years after diagnosis of MM. The population was divided into three periods, which included: group A (1970 to 1985), group B (1986 to 1999) and group C (2000 to 2015). Results: The median OS (mOS) of all patients was 3.6 years (95% CI: 3.2-3.8) from diagnosis. When demographic effects of age, sex, and year of diagnosis were compensated, the RS showed a continuous improvement during the periods analyzed, more pronounced in group C. The 5-year and 10-year RS were 26% and 8% in group A, 36% and 18% in group B, and 56% and 33% in group C, p < 0.01. In the stratified analysis by age and sex, group B and C retained its prognostic value in terms of IRR compared with group A (Figure 1). The EM rate (first 60 days after diagnosis) was 5.8%; 16.5% in Group A, 5.5% in Group B, and 2.6% in Group C; p < 0.01. The most frequent causes of early mortality were disease-related (46.7%, 63.6% and 66.6%; respectively), and infectious complications (36.7%, 22.7%, and 20.0%; respectively). In the multivariate Cox proportional hazard model in patients who received novel drugs, thrombocytopenia (OR 5.07, p = 0.04), hypercalcemia (OR 11.5, p < 0.01) and high beta-2 microglobulin (OR 8.81, p < 0.01) were significantly associated with EM. Regarding long-term survival, in the multivariate analysis, clinical variables at diagnosis associated with >10-year survival were age <60 years (OR 2.23, p = 0.02), and performing ASCT (OR 4.25, p < 0.01). Summary/Conclusion:This study shows that the survival outcome has significantly improved over the last decades in all age groups, probably due to ASCT and novel drugs. The incidence of EM has decreased over time, being the most frequent causes of MM progression and infectious complications. Thrombocytopenia, hypercalcemia and high beta-2 microglobulin were associated with worst early outcomes. Finally, these data identify age <60 years, and ASCT as important predictors of longterm survival.
Остеопороз (ОП) -заболевание скелета, для которо-го характерны снижение прочности кости и повышение риска переломов. Прочность кости отражает интеграцию двух главных характеристик: минеральной плотности ко-сти (МПК) и качества кости (архитектоника, накопление повреждений, минерализация) [1][2][3]. Социальное значе-ние ОП определяется его последствиями -переломами позвонков и костей периферического скелета, которые обусловливают значительный подъем показателей инва-лидности и большие материальные затраты в области здравоохранения [1].ОП в ревматологии рассматривается не только как само-стоятельное заболевание скелета, но и как одно из наиболее тяжелых и часто встречающихся осложнений большинства хронических ревматических заболеваний, а также противо-ревматической терапии. Интерес к проблеме вторичного ОП и многочисленные исследования, в том числе крупные про-спективные когортные, а также метаанализы, систематиче-
Background infringement of a metabolism of bone tissue caused by inflammation, increases the risk of developing osteoporosis (OP) and can be considered as an indicator of “seriousness” of the disease and the activity of inflammation. Objectives assess bone mineral density in men with ankylosing spondylitis (AS) depending on x-ray stage of the disease. Methods Under the supervision were 70 male patients with a diagnosis of as. The average age of patients 43,2±9.1 years. Patients were included in the study in a different time period from the onset of the speakers: 4.3 per cent in the first year of illness, 21,4% - while ago as 1 - 4 years, with the duration of 5-9 years - 25,7% and 48.6% of patients have 10 years or more. Among the 70 patients of 62.8% had only axial defeat. In 60,0% of cases in the radiography of spine identified Sindesmofitis, of them in the lumbar spine of 52.3% of patients, breast - 45.2% and in the cervical - 35,7%. Sindesmofitis in two departments of a backbone identified the 35,7%, and in all departments, 15% of patients, till the formation of the symptoms of “bamboo sticks.” Results When comparing the densitometric parameters in the groups of patients depending on radiological stage statistically significant decreasing of densitometric parameters of the proximal femur as the progression of radiographic changes. So, in men with I-II x-ray stage AU IPC hip was 947,8±15,13 g/cm2, which corresponds to -2,16±0,12 standard deviations by Z-test, while in stage III-IV AC IPC - 880,9±26,83 g/cm2, which corresponds to -2,66±0,19 standard deviations on the Z-test (p=0,0136 and R?0,001). However, in the lumbar spine densitometric parameters IPC increase as the progression of radiological stage. IPC at I-II stage was 1007,33±27,76 g/cm2 and -1,08±0.15 standard deviations by Z-test compared with the IPC with stage III-IV AC 1179,81±31,94 g/cm2 and -0,20±0,17 standard deviations on the Z-test (p=0,0106 and p=0,0216). Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4162
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