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AIM: To study the frequency of hypogonadism (HG) in men with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) and to evaluate the impact of HG on the course of RA and and concomitant diseases. MATERIALS AND METHODS: A single-stage continuous study included 170 men with RA, 57 men with AS and 85 men with PsA, who were hospitalized at the Nasonova Research Institute of Rheumatology. Patients were assessed for total testosterone (ТS) levels and subsequently divided into subgroups with normal (>12 nmol/l) and reduced levels. An intergroup comparison was carried out on the main indicators used in clinical rheumatological practice to assess the stage, activity and other medical and demographic characteristics of rheumatic disease, as well as on concomitant conditions. The second stage of the study involved a pairwise intergroup comparison among patients with HG with RA, AS and PsA. RESULTS: The incidence of ТS deficiency among patients with RA was 24.1%, among patients with AS - 17.5%, and with PsA - 31.8%. In patients with RA, HG was associated with a significantly higher mean body mass index, higher fasting blood glucose and uric acid, higher erythrocyte sedimentation rate and anemia. Patients with AS with HG had significantly lower hemoglobin levels and more frequent anemia, as well as higher levels of C-reactive protein and erythrocyte sedimentation rate. In PsA, older age was observed in the androgen deficiency group, as well as higher body mass index and fasting glucose levels; obesity was more common. An intergroup comparison of quantitative and qualitative indicators between patients with androgen deficiency in all three rheumatic diseases (RDs) did not reveal significant differences in the average concentrations of ТS, luteinizing hormone, sex hormone binding globulin, experience of RD, laboratory markers of inflammatory activity, as well as glucose and uric acid. A similar incidence of diabetes mellitus, obesity and anemia was noted for all three nosologies. CONCLUSION: ТS levels and the presence of HG were not associated with the stage and activity of RD, but ТS deficiency was accompanied by higher laboratory indicators of inflammatory activity, lower hemoglobin values, and metabolic disorders. Patients with HG, regardless of nosology, had similar levels of sex hormones and indicators reflecting RD and concomitant conditions.
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Artritis Psoriásica , Artritis Reumatoide , Hipogonadismo , Testosterona , Humanos , Masculino , Hipogonadismo/epidemiología , Hipogonadismo/sangre , Hipogonadismo/diagnóstico , Persona de Mediana Edad , Testosterona/sangre , Artritis Psoriásica/epidemiología , Artritis Psoriásica/complicaciones , Artritis Psoriásica/diagnóstico , Artritis Psoriásica/sangre , Adulto , Artritis Reumatoide/epidemiología , Artritis Reumatoide/complicaciones , Artritis Reumatoide/sangre , Artritis Reumatoide/diagnóstico , Espondilitis Anquilosante/epidemiología , Espondilitis Anquilosante/complicaciones , Espondilitis Anquilosante/diagnóstico , Espondilitis Anquilosante/sangre , Espondilitis Anquilosante/fisiopatología , Federación de Rusia/epidemiología , Incidencia , Sedimentación SanguíneaRESUMEN
Autoimmune polyglandular syndromes (APS) are a heterogeneous group of clinical conditions characterized by functional impairment of multiple endocrine glands due to loss of central or peripheral immune tolerance. These syndromes are also often accompanied by autoimmune damage to non-endocrine organs. Taking into account the wide range of components and variants of the disease, APS is usually divided into a rare juvenile type (APS 1) and a more common adult type (APS 2-4). APS type 1 is caused by a monogenic mutation, while APS types 2-4 have a polygenic mode of inheritance. One subtype of adult APS (APS 3D) is characterized by a combination of autoimmune thyroid disease and autoimmune rheumatic disease. This review considers the available literature data on combinations that meet the above criteria. Many studies have noted a significantly higher prevalence of rheumatic diseases in patients with autoimmune thyroid disease compared with the control group. Also, as in a number of rheumatic diseases, a more frequent occurrence of autoimmune thyroiditis, primary hypothyroidism and Graves' disease was noted.
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Enfermedades Autoinmunes , Enfermedad de Graves , Poliendocrinopatías Autoinmunes , Enfermedades Reumáticas , Adulto , Humanos , Poliendocrinopatías Autoinmunes/diagnóstico , Poliendocrinopatías Autoinmunes/epidemiología , Poliendocrinopatías Autoinmunes/genética , Enfermedades Autoinmunes/complicaciones , Enfermedad de Graves/complicaciones , Síndrome , Enfermedades Reumáticas/epidemiología , Enfermedades Reumáticas/genética , Enfermedades Reumáticas/complicacionesRESUMEN
The prevalence of obesity in the modern world is increasing. Obesity is an independent risk factor for some rheumatic diseases and also worsens their course. The presence of chronic joint disease can make it difficult for obesity to reduce activity, creating a vicious circle where joint pain makes exercise difficult and being overweight exacerbates joint pain. At the same time, there is a conditionally radical method of treating obesity - bariatric surgery (BS), which is currently used when conservative methods are ineffective. The purpose of this review is to analyze the data presented in the world literature on the impact of BS on the course of the most common rheumatic diseases. The available data show the possibility of a positive effect of BS not only on weight loss, but also on the course of a number of rheumatic diseases.
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Cirugía Bariátrica , Artropatías , Errores Innatos del Metabolismo , Obesidad Mórbida , Enfermedades Reumáticas , Humanos , Obesidad Mórbida/complicaciones , Obesidad Mórbida/cirugía , Artropatías/complicaciones , Artropatías/cirugía , Artralgia , Cirugía Bariátrica/efectos adversosRESUMEN
BACKGROUND: It has been suggested that the presence of chronic immunoinflammatory rheumatic disease (CIRD) may be a factor that increases the likelihood of developing hypogonadism syndrome, and conversely, the presence of uncompensated testosterone deficiency may predispose to a greater risk of developing or more severe course of ICRD. AIM: To study the incidence of hypogonadism in men with rheumatoid arthritis (RA) and evaluate its impact on the course of RA and concomitant diseases. MATERIALS AND METHODS: A one-time continuous study included 170 men with RA who were undergoing inpatient treatment at the Federal State Budgetary Institution NIIR named after. V.A. Nasonova. Patients were assessed for total testosterone levels and subsequently divided into subgroups with normal (>12 nmol/l) and reduced levels. An intergroup comparison was carried out on the main indicators used in clinical rheumatological practice to assess the stage, activity and other medical and demographic characteristics of RA, as well as the state of purine and carbohydrate metabolism. A correlation analysis was performed between the level of total testosterone and some clinical and laboratory parameters. RESULTS: The frequency of detected testosterone deficiency in the study group was 24.1%. Significant correlations were noted between the level of total testosterone and body mass index (r=-0.29), the level of blood uric acid (r=-0.19) and C-reactive protein (r=-0.18). Patients with hypogonadism compared to the group with normal testosterone levels were characterized by higher body mass index (29.3±5.6 vs 26.3±4.0 kg/m2; p<0.001), glucose levels (6.95±7 .85 mmol/l vs 5.42±1.13 mmol/l; p=0.034) and uric acid (354.6±110.7 vs 317.5±84.8 µmol/l; p=0.03) blood. In addition, patients with hypogonadism were more likely to suffer from obesity (41.6% vs 15.7%; p=0.001) and diabetes mellitus (21.6% vs 10.2%; p=0.075) without a statistically significant difference, and also had higher ESR (46.5±42.2 vs 31.0±30.9 mm/h; p=0.012). A more frequent occurrence of anemia was noted in hypogonadism (32.4% vs 16.7%; p=0.041). CONCLUSION: Testosterone levels and the presence of hypogonadism were not associated with the stage and activity of RA, however, testosterone deficiency was accompanied by a more frequent development of overweight and obesity, and a deterioration in purine and carbohydrate metabolism.
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Artritis Reumatoide , Hipogonadismo , Testosterona , Humanos , Masculino , Testosterona/sangre , Testosterona/deficiencia , Artritis Reumatoide/sangre , Artritis Reumatoide/complicaciones , Artritis Reumatoide/epidemiología , Persona de Mediana Edad , Hipogonadismo/sangre , Hipogonadismo/epidemiología , Adulto , AncianoRESUMEN
Sexual dimorphism of chronic diseases is a phenomenon determined by differences in the hormonal status of men and women. In this regard, estrogens, which have a complex effect on the body, are of great interest. In particular, estrogens play an important role in the natural control of pain and inflammation. A decrease in estrogen levels associated with menopause or iatrogenic effects (hysterectomy, use of aromotase inhibitors), as well as mutations of genes responsible for the synthesis of structural components of membrane estrogen receptors (ESR1 and ESR2), can significantly reduce the positive effects of these hormones. Deficiency of estrogen can become one of the reasons for the development of serious pathological changes in particular, the formation of chronic pain associated with the pathology of the musculoskeletal system.
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Dolor Crónico , Enfermedades del Sistema Endocrino , Dolor Musculoesquelético , Masculino , Femenino , Humanos , Receptores de Estrógenos/genética , Dolor Musculoesquelético/etiología , Dolor Crónico/etiología , Estrógenos , MenopausiaRESUMEN
The purpose of the study was to analyze the frequency of detection of vitamin D deficiency in elderly people, identify clinically significant diseases, accompanied by a deficiency of vitamin 25(OH)D. A retrospective cohort study was conducted in 506 patients over 65 years of age (74,1±6,5 years). Patients were divided into three age groups: group A 65-74 years, group B 75-84 years, group C 85 years and older. The study of blood samples was carried out from September to May. The level of vitamin 25(OH)D was determined by the method of chemiluminescent immunoassay on the Abbott Architect 8000 analyzer (USA). Evaluation of vitamin 25(OH)D was performed according to the clinical recommendations of the Russian Endocrinology Association and the recommendations of the Russian Association for Osteoporosis. Among people older than 65 years, the average level of 25(OH)D was 20,9 ng/ml (range 2,3 to 70,5 ng/ml), 50% had vitamin D deficiency. With age, the proportion of patients with vitamin D deficiency increased more in the male population. Low values of vitamin 25(OH)D were more frequent in the spring. Arterial hypertension, obesity of varying degrees, sarcopenia increased the risk of vitamin D deficiency in 1,15-1,17-1,2 (Ñ<0,05-0,01) times, respectively. Oncological diseases in the anamnesis were accompanied by low parameters of vitamin 25(OH)D in blood serum (p=0,084).
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Deficiencia de Vitamina D/diagnóstico , Vitamina D/sangre , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Estudios Retrospectivos , Federación de RusiaRESUMEN
The purpose of our study was to evaluate the parameters of the stabilogram in people over 65 years of age and to identify the parameters of the stabilometric study, which had statistically significant connections with falls and fractures.The study included 308 patients older than 65 years, living in their own homes. To perform the research tests with open (OG) and eyes closed (MO). It uses the European approach positioning stop on the platform: the patient is installed in the position of the foot heels together, toes apart. Patients during the testing behavior did not use orthopedic vehicles as walkers, walking sticks.The study found gender differences in the speed V (p<0,01) and area S (p<0,01), the center of pressure stop (CD) on at Stabiloplatform conducting tests with open and closed eyes. At the age of 85 years found significant deviations of speed (V) CD stabilogram in open and closed eyes tests (p<0,01), corresponding to a high frequency of falls 61,36% (95% CI 45,5-75,6; p<0,05). In patients with rare (other) fractures, there were deviations in the mean direction of the oscillations during a sample with open eyes ï (OG) (p<0,05). There were no statistically significant differences in the stabilometric parameters in the presence of hip fractures and vertebral fractures (p>0,05). Thus, the stabilometry method can be used in elderly people for early detection of imbalance and the risk of developing falls that will prevent the development of fractures.
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Accidentes por Caídas/estadística & datos numéricos , Fracturas Óseas/epidemiología , Anciano , Anciano de 80 o más Años , Femenino , Fracturas de Cadera/epidemiología , Humanos , Masculino , Equilibrio Postural , Factores de Riesgo , Fracturas de la Columna Vertebral/epidemiologíaRESUMEN
The purpose of the study was to examine the problem of falls in the elderly. A prospective cohort study of 537 patients over 65 years using validated questionnaires and functional tests. 56,58 % of patients had at least one fall event in the 12 months prior to the observation. 82,76 % of all falls are over the age of 85 years. Significantly more patients younger than 85 years fell in the autumn and winter (to 17,64 and 25,93 %, respectively) and over the age of 85 years in 50 % of cases (95 % CI 28,2-71,8) fell summer. Polypharmacy and comorbid conditions increases the risk of falls. 32,89 % of people over 65 years in the fall received fractures. However, a fracture of the femoral neck in 60 % of cases diagnosed over the age of 85 years. Hypodynamy observed in 69,77 % of cases.
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Accidentes por Caídas , Actividades Cotidianas , Accidentes por Caídas/prevención & control , Accidentes por Caídas/estadística & datos numéricos , Factores de Edad , Anciano , Anciano de 80 o más Años , Comorbilidad , Femenino , Fracturas Óseas/etiología , Fracturas Óseas/prevención & control , Evaluación Geriátrica/métodos , Disparidades en el Estado de Salud , Humanos , Masculino , Polifarmacia , Estudios Prospectivos , Factores de Riesgo , Federación de Rusia/epidemiología , Estaciones del Año , Encuestas y CuestionariosRESUMEN
The article presents the results of prospective longitudinal study. The aim of the study was to investigate influence of complex therapy with chondroitin sulfate on pain and functional disorders in elderly patients with knee osteoarthritis. The study shows sufficient decreasing of pain, stiffness and functional disorders with complex therapy with chondroitin sulfate in comparison with nonsteroidal anti-inflammatory drugs (NSAID) by the second month of therapy with stable effect the next 2 months. All patients decrease their NSAID intake by the end of the study. Satisfaction of complex therapy was high according to patient's and physician's opinion.
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Sulfatos de Condroitina/administración & dosificación , Osteoartritis , Edad de Inicio , Anciano , Antiinflamatorios no Esteroideos/administración & dosificación , Artralgia/diagnóstico , Artralgia/fisiopatología , Artralgia/terapia , Terapia Combinada , Monitoreo de Drogas , Femenino , Humanos , Inyecciones Intramusculares , Masculino , Persona de Mediana Edad , Osteoartritis/diagnóstico , Osteoartritis/epidemiología , Osteoartritis/fisiopatología , Osteoartritis/terapia , Dimensión del Dolor/métodos , Educación del Paciente como Asunto , Rango del Movimiento Articular , Factores de Riesgo , Autocuidado/métodos , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Postmenopausal osteoporosis is a progressive systemic disease of the skeleton, characterized by a decrease in bone mass and a violation of the architectonics of bones, accompanied by an increased tendency to fractures. Osteoporosis is an important medical and social problem due to its high prevalence and frequent complications - skeleton bone fractures, which lead to temporary and permanent disability, worsen the quality of life, and increase mortality, especially among the elderly. According to various authors, mortality rates during the 1st year after a femoral neck fracture range from 12 to 40%. In half of the patients who survived after the fracture, the ability to self-care is significantly limited or lost.
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AIM: Screening of the population sample for articular pain and swelling. MATERIAL AND METHODS: A screening questionnaire for detection of arthritides and arthralgias was filled in for each adult rural and urban citizen aged over 18 years from 15 RF regions. Rural population was covered with a complete examination, urban one was examined by formation of a representative sample from general population. The screening covered a total of 31424 persons, mean age of whom was 47.6 +/- 17.6 years. Among them 14001 lived in the cities and 17423 in the villages. 61% respondents were women. RESULTS: Prevalence of arthralgias in the population reaches 46%. While the symptoms alleviated with time in 8%, they became chronic in the rest. The articular complaints rate in the population is sex-related and depends on the age. In persons under 20 years arthralgia occurs in 9%. Urban citizens have articular pains more frequently than rural population--43 and 33%, respectively. CONCLUSION: Pilot results of the screening program demonstrate prevalence of arthralgias in Russia and the importance of joint pathology problem in Russia.
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Artralgia/epidemiología , Artritis/epidemiología , Población Rural , Población Urbana , Adulto , Anciano , Femenino , Humanos , Incidencia , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Prevalencia , Encuestas y CuestionariosRESUMEN
Thirty-five RA patients with the disease history from 3 months to 15 years were examined. Seropositive RA was diagnosed in 19 patients, seronegative in 16 ones. A control group comprised 14 subjects aged 18-29. The marrow cells culturing occurred in the system agar drop-liquid. Compared to the reference group, in RA patients' precursor cells of granulomonocytopoiesis there was inhibited capacity for colony and cluster formation and predominance of small-size cell colonies. Colony-formation of marrow cells from seropositive RA patients was less active than in seronegative RA variant. Morphologic evaluation of the agar cultures showed prevalence of neutrophil colonies in the marrow cultures, though RA samples differed from those of healthy controls by a trend to a decline in the number of monocyte-macrophage cellular aggregates against similar proportions of eosinophilic colonies and clusters.