Object of the research: diabetic-associated osteoarthritis. The aim of the study comprehensive clinical and laboratory study of risk factors, features of the course and pathogenesis of diabetes-associated osteoarthritis, development of scientifically sound criteria for diagnosis and optimization of treatment of arthropathies in patients with diabetes mellitus (DM) 1 and 2 types. Methods of the investigation and equipment: general clinical, biochemical, radiological, instrumental, enzyme-linked immunosorbent assay, radiological, statistical, parametric and nonparametric. Spectrophotometer Star fax-3200 (USA), analyzer company Human (Germany), gamma camera GK S301TSKTB "Horizon". Theoretical and practical results: the paper presents for the first time the results of a comprehensive study of risk factors and pathogenetic mechanisms of joint pathology in patients with type 1 and 2 diabetes, which made it possible to develop an algorithm for diagnosis and treatment of affected joints depending on type of diabetes. It was found that the most significant modifying factors for the prevention and progression of arthropathy are HbAIc - 8% for patients with type 1 diabetes and 8.2% - for patients with type 2 diabetes, as well as BMI - 25 kg / m2 for patients with type 1 diabetes and 27 kg / m2 - for patients with type 2 diabetes. It is proved that the presence of three of the following complications of diabetes: nephropathy, retinopathy, polyneuropathy, angiopathy of the lower extremities is the basis for diagnostic procedures for joint damage, even in the absence of clinical symptoms of arthropathy. It is shown that in the presence of diabetic arthropathy all structures of the joint are involved in the pathological process, diagnostic criteria characterizing the lesions of different joint structures are determined. The effectiveness of non-steroidal anti-inflammatory drugs in a short course with the use of injectable and tablet forms has been shown. It has been proven that the use of chondroprotectors in the treatment of diabetic arthropathy is effective, but requires correction of antihyperglycemic therapy throughout the course of treatment. The results allow to develop protocols for the diagnosis and treatment of diabetic arthropathy depending on the type of diabetes, which will help in the early diagnosis of joint damage and improve treatment regimens for diabetic associated osteoarthritis. Novelty: for the first time a comprehensive study of joint damage in patients with the definition of risk factors and described the phenotypic features of diabetes-associated osteoarthritis in patients with type 1 and type 2 diabetes. It was found for the first time that patients with type 1 diabetes with joint damage are characterized by an increase in osteocalcin, which is due to compensatory activation of remodeling of subchondral bone tissue on the background of initial changes in the joints. The cytokine links of immunoregulation of diabetic-associated osteoarthritis depending on the type of diabetes have been studied. For the first time, biochemical rheumatological parameters in patients with type 1 and type 2 diabetes with diabetes-associated osteoarthritis were studied. The study evaluated biochemical parameters that reflect the synthetic and catabolic phases of metabolism of the main components of connective tissue - collagen and glycosaminoglycans in patients with diabetes-associated osteoarthritis. Also, for the first time in patients with diabetic arthropathy, the level of oligomatrix cartilage protein was determined - a biochemical indicator that reflects the violation of cartilage integrity. Radionuclide angiography and radionuclide scintigraphy of the knee and ankle joints were performed in patients with diabetes-associated osteoarthritis. Improved treatment regimens for diabetic arthropathies have been proposed, taking into account the peculiarities of carbohydrate metabolism and possible target organ damage in patients with diabetes, and their effectiveness has been proven. The degree of implementation: the results of the study are implemented in the practice of the health care system of Ukraine. Areas of application: endocrinology.
