Correlation of Osteoporosis and Vegetative Dysfunction in Rheumatoid Arthritis
Relevance. Rheumatoid arthritis (RA) belongs to the most common inflammatory diseases of the joints, and the number of patients with this pathology increases everywhere, causing enormous medical, social and economic damage. An important role in the pathogenesis of RA is given to dysfunctions of the autonomic neural system (ANS), which condition is closely related to the bone metabolism and bone mineral density. The purpose and objectives: to assess the incidence of osteoporosis at different «vegetative passport» of RA patients, to explore the relationship of vegetative dysfunction (VD) signs with the nature of bone density. Material and methods. There were examined 173 patients with RA aged 18 to 79 years (average age — 46 years), among them 21 % males and 79 % females. The duration of disease manifestations was 10 years, variation of RA, seropositive for rheumatoid factor and citrulline antibodies, was detected in 3/4 of cases, extraarticular (systemic) form of the disease was diagnosed in 37 % of cases. Results. Osteoporosis develops in 2/3 of RA patients, and its pathogenic constructions are closely associated with the presence of VD, the severity of which is correlated with indicators of bone density, and those, in turn, — with parameters of variation pulsometry, activity and bone-destructive components of articular syndrome, depends on the vegetative type of patients (vagotonia is more typical for patients with osteoporosis, and for the rest of the patients — sympathotony). The imbalance of bone metabolism markers in RA patients enhances the existing violations of ANS, and the content of magnesemia has prognostic value in relation to VD. Its severity correlates with the severity of osteoporosis, wherein unfavorable prognostic indicators are blood calcium level more than 80 mg/l and alkaline phosphatase activity over 180 U/l. Conclusion. The development of osteoporosis is associated not only with features of the articular syndrome course and extraarticular RA symptoms, but also with the state of the ANS, which is involved in the pathogenetic constructions of bone density reduction and imbalance of bone metabolism markers. In the future, the active identification of VD will be useful for subsequent timely rehabilitation.
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