Masyk O. Diagnosis, prevention and treatment of systemic disturbances of bone mass in patients with rheumatoid arthritis and ankylosing spondylоarthritis

The thesis is devoted to the problem of improvement of quality of secondary prevention and treatment of patients with rheumatoid arthritis and central form of ankylosing spondyloarthritis. This is achieved by the establishment of mechanisms and amelioration of diagnosis of systemic disturbances of bone tissue metabolism, evaluation of their role for the clinical course of the diseases as well as by the differential preventive measures. We have analysed the results of experiments on white rats with three models of osteoporosis and the results of the five years' follow-up of 139 patients with rheumatoid arthritis and of 81 patients with the central form of ankylosing spondyloarthritis. The prevalence of systemic osteopathy, the tendency and the rate of its evolution in patients with rheumatoid arthritis and central form of ankylosing spondtlarthritis have been established. The concept of bone mass changes sequence in patients with central form of ankylosing spondyloarthritis has been proposed, based on the algorithm of densitogram analysis in these patients. The negative influence of osteodystrophy on the clinical course of the disease has been revealed. The main clinical factors which determine the degree and the rate of bone mass changes in these patients have proved to be age, gender, radiological stage of the disease, and state of the menstrual function, while the bone mass condition and its changes rate are the manifestations of the permanent immunocomplex inflammation, the significance of which depends on the stage of the disease. Standard methods of treatment appeared to be not helpful for the bone mass prevention. Original approaches to interpretation, monitoring and prognosis have been proposed, the efficacy of the modified treatment programs for prevention and treatment of osteodistrofy in patients with rheumatoid arthritis and central form of ankylosing spondyloarthritis has been proved.