The dissertation research provides a theoretical justification of etiology and pathogenesis. Taking into account new scientific data on genetic and clinical-pathogenetic features, diagnostic and therapeutic and preventive measures in patients with osteoarthritis (OA) of the knee joints, burdened by comorbidity, were optimized.
Guided by clear inclusion and exclusion criteria, 110 patients were selected for our study and divided into groups: Group I - patients with OA (n = 30), Group II - with OA and arterial hypertension (AH) (n = 40) and Group III - with OA, AH and type 2 diabetes mellitus (DM2) (n = 40). The control group included 30 practically healthy individuals.
The following research methods were used in the framework of the dissertation: general clinical, determination of quality of life (QOL) and condition of the affected joint (MOS SF-36 (Medical Outcome Study Short Form-36) and KOOS (Knee injury and Osteoarthritis Outcome Score) questionnaires), biochemical (determination of the activity of reduced glutathione (RG), glutathione-S-transferase (GST) and glutathione peroxidase (GP), plasma and erythrocyte malonaldehyde (MA pl., er.), carbohydrate, lipid, mineral spectrum of blood, final metabolites of nitric oxide (NO)), enzyme-linked immunosorbent assay (content of endothelin-1 (ET-1), C-reactive protein (CRP), interleukin-6 (IL-6), vitamin D, calcitonin), molecular genetic (study of the BsmI (rs1544410) polymorphism of the VDR gene), instrumental (radiography, blood pressure (BP) measurement, electrocardiography (ECG)) and statistical.
Scientific novelty of the results obtained. For the first time, a comprehensive determination of the level of vitamin D, the state of mineral and carbohydrate metabolism, the blood lipid spectrum and indicators of the state of the endothelium, pro-inflammatory cytokines, indicators of lipid peroxidation and antioxidant protection was carried out and the pathogenetic relationships between these indicators were traced in OA with comorbid hypertension and DM2, taking into account the BsmI polymorphism of the VDR gene.
The knowledge about the features of the clinical course (symptoms, complaints, physical functioning) and their impact on QOL in conditions of OA comorbidity was supplemented. The above-mentioned studies conducted by us made it possible to understand the pathogenetic mechanisms, improve diagnostics and allowed us to identify indicators that will help in the early detection of OA or hypertension, DM2 and substantiate the algorithm of treatment, prevention, taking into account comorbidity and BsmI polymorphism of the VDR gene.
Practical significance of the results obtained. The implementation of the results of our dissertation research into clinical practice allowed us to improve diagnostics using the KOOS and MOS SF-36 questionnaires, which allows us to determine the effectiveness of treatment. In order to reduce pain syndrome, the intensity of symptoms and complaints, improve physical activity, reduce the patient's stay in the hospital, improve the functional ability of the affected knee joint and the quality of life of patients with comorbid OA, the use of cholecalciferol to basic treatment is proposed.
The results of the work are used in the work of therapeutic, rheumatological, cardiological, endocrinological departments, family medicine of medical institutions of various levels.
The results of the dissertation research were implemented in the medical work of the rheumatology department of the regional municipal non-profit enterprise "Chernivtsi Regional Clinical Hospital", the municipal non-profit enterprise "Storozhynsk Multidisciplinary Hospital of Intensive Care" of the Chernivtsi region, the municipal non-profit enterprise "Sniatyn Multidisciplinary Hospital" of the Ivano-Frankivsk region, the municipal non-profit enterprise "Dunayevtsi Multidisciplinary Hospital", the municipal non-profit enterprise "Horodok City Multidisciplinary Hospital" of the Khmelnytskyi region, as well as in the educational process of the Department of Internal Medicine of the Bukovina State Medical University.
