The Markers Of Bone Metabolism And System Inflammation In Patients With Osteoarthritis Depending On Body Mass, The Influence Of Symptomatic Slow Acting Drugs

Aim. To assess the levels of markers of the bone synthesis and system inflammation in patients with osteoarthritis (OA) in combination with obesity and their dynamic under the influence of basic treatment.Materials and methods. The research included 40 women with OA, 46–78 years old (mean age – 59,8±1,5 years). Duration of the disease varied from 3 to 36 years (mean duration – 10,0±1,1 years). Mean body mass index (BMI) among patients was 30,6±0,7 [22,3; 39,5]kg/m2, according to which patients were divided in 3 groups: patients with OA without obesity (n=17), patients with OA with 1 degree of obesity (n=14), patients with OA with 2 degree of obesity (n=9). The level of osteochondral metabolism was assessed using quantitative measuring of the levels of procollagen IC-terminal propeptide (РІСР), (Cloud-CloneCorp. “procollagen IC-Terminal Propeptide”, USA) and osteocalcin (Roche Diagnostics «N-MID Osteocalcin», Switzerland) on analyzer «ELECSYS 2010» by the method of immune-enzyme analysis; the level of the system inflammation was assessed by the level of C-reactive protein (CRP) by the method of immunoturbidimetry. The clinical efficacy was assessed by the dynamics of intensity levels of pain syndromes at physical load and at rest by the visual-analogue scale (VAS). The measuring of РІСР, osteocalcin and CRP levels and also the assessment of clinical efficacy as to the decrease of pain syndrome were carried out twice – at the beginning and at the end of observation. The period of observation is 2 months.Results. The presence of direct correlation between РІСР and BMI (r=0,62; р=0,008) among patients with OA in combination with the normal body weight was established at the research, whereas among patients with OA in combination with obesity the analogous correlation was demonstrated between SRP and BMI (r=0,43; р=0,04) on the background of correlation of PICP and OC levels (r=0,46; р=0,03).Obesity in patients with OA was associated with the reliably higher levels of pain at both rest and physical load from the side of knee joints, with maximal intensity of the pain syndrome among patients with OA and 1 degree of obesity.Statistical analysis did not reveal the reliable dependence of РІСР and OC in patients with OA from the initial CRP level on the background of tendency to the higher РІСР level and lower OC level among patients with initially increased CRP level comparing with ones with normal CRP level. The therapy with basic preparations at OA during 2 months among patients with OA with increased CRP level led to the reliable decrease of РІСР level (р=0,0076) and the tendency to increase of OC level (р˃0,05), without the reliably significant difference between the initial and final РІСР and OC levels among patients with OA and normal CRP level.At the end of observation period the maximal analgesic effect was demonstrated as to the articulate pain at rest from the side of knee joints (р˂0,001) among patients with OA, who received diacerein, with clinically comparable effect from the side of other aticulate zones (р˂0,05), that was associated with reliable decrease of CRP level (р=0,013).Discussion. The received results testify that the control of the system inflammation level at OA is a target not only relative to the decrease of pain syndrome but also conditions the stable state of subchondral bone (SCB), providing the compensation of processes of destruction and synthesis in bone tissue. The significance of procollagen IC-terminal propeptide (РІСР) and osteocalcin (OC) as the markers of bone synthesis that are able to reflect metabolic processes in SCB at OA, and also the discordant influence of CRP level on PICP level at the relative stability of OC level were demonstrated at the research.The received results allow consider the inflammatory process at OA as a target for preservance of the bone tissue, conditioning the expedience of taking into account the ability of OA basic preparations to realize the control influence on the level of system inflammation. Diacerein that in ESCEO recommendations (2014) is related to the preparations of the 1 step of treatment of patients with OA provides the control on inflammation and stability of osteocalcin level that testifies to the balance of catabolic processes in SCB.Conclusions. At OA the levels of procollagen IC-terminal propeptide (РІСР) and osteocalcin (OC) were not associated with obesity and did not depend on the initial CRP level at the presence of correlation between РІСР level and BMI among patients with OA with the normal body weight and BMI and CRP level among patients with OA in combination with obesity.The absence of reliable dynamics from РІСР side and maintenance of the stable OC level on the background of the reliable anti-inflammatory effect at using diacerein in patients with OA can testify to the compensatory adequacy of reparation processes in SCB

The Interrelation of Insulin Resistance, Serum Adiponectin Level inRheumatoid Arthritis Hypertensive Females with Subclinical Atherosclerosisand its Dynamics with the Endothelial Dysfunction Correction

The study shows the results of comprehensive clinical and laboratory, instrumental, biochemical examination of 62 hypertensive females aged 45-65 years with rheumatoid arthritis, there were summarized data on the role of main and additional risk factors in the assessment of overall cardiovascular risk in these patients by studying their relationship with subclinical atherosclerosis presence. Subclinical manifestations of atherosclerosis in hypertensive patients with rheumatoid arthritis characterized by a carotid pool lesions predominance with significantly higher atherosclerotic plaques frequency definition in comparison with a group isolated rheumatoid arthritis, including unfavorable structure. However, cardiovascular risk structure by mSCORE in hypertensive patients with rheumatoid arthritis and subclinical atherosclerosis manifestations shows moderate risk dominating. The thesis shows the presence of atherosclerotic plaques in patients with hypertension combined with rheumatoid arthritis associates with endothelial dysfunction, hyperinsulinemia, age and duration of glucocorticoid therapy (based on logistic regression analysis). It was determined the role of adiponectin as a marker of atherosclerotic carotid arteries. It was estimated the effectiveness of complex therapy with oral L-Arginine solution in the normalization of endothelial dysfunction, insulin resistance reducing in hypertensive patients with rheumatoid arthritis

Adiponectin level, insulin resistance, endothelial dysfunction in females with rheumatoid arthritis and comorbid hypertension

Background : Rheumatoid arthritis (RA) associates with accelerated atherosclerosis and high cardiovascular mortality. Cardiovascular risk assessment in RA pts with comorbid hypertension (HT) is do not fully reflected by traditional risk scales, thus additional factors searching is required. Objectives: We aimed to estimate the adiponectin level, insulin resistance, endothelial function in RA females with comorbid HT and its relationship with subclinical manifestations of atherosclerosis. Methods: The study included 82 RA females with low disease activity and comorbid HT (mean age of 54.6 [49.7; 62.5] years) and 40 HT females without RA (control group). All pts received stable therapy of RA more than 6 months. Pts with coronary artery disease were excluded

Cardiovascular and nephrological risk in patients with chronic kidney disease in ambulatory care.

Patients with chronic kidney disease (CKD) have higher than in general population all-cause and cardiovascular mortality. Arterial hypertension (HTN) is a powerful potentially modifiable risk factor that affects the majority of patients with chronic kidney disease and one of the main causes of end stage renal disease worldwide. Existing tools for assessment of risk of CKD progression do not take into account arterial hypertension. The aim – to investigate the association between cardiovascular and nephrological risk factors in patients with CKD in ambulatory practice. The study was carried out in the Center of Nephrology Care in Mechnikov Dnipropetrovsk Regional Hospital, Dnipro, Ukraine. 278 patients (114 males and 164 women, aged 41 [31;61] years) with CKD (stages 1-3) who were followed-up in ambulatory care, but required diagnosis or treatment revision were enrolled to the study. All patients were examined and followed-up according to local and European standards. Females slightly prevailed in our study, gender distribution varied insufficiently in groups by CKD progression risk. Elevation of risk of CKD progression was accompanied by rise of prevalence of diabetes mellitus, left ventricle hypertrophy, proteinuria and HTN.  Risk of CKD progression correlated with age, systolic and diastolic blood pressure, erythrocyte sedimentation rate, total cholesterol, glomerular filtration rate, albumin excretion rate, duration of HTN and body mass index. Rise of cardiovascular risk was accompanied by rise of proportion of patients with high risk of CKD progression. Increase in risk of CKD progression is associated with rise of burden of cardiovascular risk factors. HTN and blood pressure values should be accounted for assessment of risk of CKD progression

Serum Matrix Metalloproteinase (Mmp)-2,9 Activity, Galectin-3 and Systemic Inflammation in Patients with Postinfarction Heart Failure with Preserved Ejection Fraction

The availabledata suggest that heart failure (HF) after myocardial infarction (MI) is a very frequent event. Recent meta-analysis showed that restrictive mitral filling pattern, the most severe form of diastolic dysfunction, was presented in approximately 10% of the patients with preserved ejection fraction. In addition, restrictive pattern was associated with poor outcome. However, the true prevalence and relevance of diastolic dysfunction after MI remains to be elucidated. Objective: study was designed to evaluate the serum level of MMP-2,9, galactin-3 and C-reactive protein (C-RP) in postinfarction heart failure with preserved ejection fraction (HFpEF) patients. Methods: We divided all included patients into two main groups: 1st group – 20 patients with HFpEF and history of myocardial infarction. 2nd group – 18 patients with HFpEF and stable angina. Standard laboratory blood tests for erythrocyte sedimentation rate (ESR), CRP,haematological parameters, lipid profile, glucose, renal and liver function tests were performed and calculated body mass index (BMI) for all patients. MMP activity assay and galectin-3 serum level was detected for all patients. Results: It was established significant differences between study groups in MMP-2, MMP-9 levels. Particularly, patients with HFpEF with MI in anamnesis had significantly higher MMP-2, MMP-9 levels on 21.8% and 20.7% respectively. The C-RP and leucocytes levels were significantly higher in 1st group pts. Significant differences in MMP-2, MMP-9 were established in 1st group patients in different age groups (p<0.05) (tab. 3). The MMP 2 level was positively correlated with MMP 9 level (R=0.73, p<0.05), the MMP 9 level – with age (R=0.68, p<0.05). There were no significant differences between galectin-3 level in study group. But we estimated significant differences in galectin-3 level between 1st and 2nd subgroups (p<0.05). Conclusion: Serum MMP-2, MMP-9, CRP and galactin-3 were significantly increased in pts with postinfarction heart failure with preserved ejection fraction compare to pts without myocardial infarction in anamnesis. Літературні дані свідчать, що серцева недостатність (CH) після перенесенго інфаркту міокарда (ІМ) є частою подією. Однак поширеність і фактори виникнення діастолічної дисфункції лівого шлуночка після перенесеного ІМ залишаються маловивченими. Мета: оцінити рівні сироваткових MMP-2,9, галактину-3 та С-реактивного білка (СРП) при постінфарктній серцевій недостатності зі збереженою фракцією викиду. Матеріали та методи: у дослідження включено 38 пацієнтів з СН зі збереженою фракцією викиду віком від 40 до 80 років: 1 група (n=20) з перенесеним інфарктом міокарда в анамнезі, 2-а група (n=18) пацієнтів зі стабільною стенокардією. Виконано стандартні лабораторні аналізи крові, визначення CРП, гематологічних параметрів, ліпідного профілю, глюкози, креатиніну. Визначення активності ММP та рівня галактину-3 в сироватці крові проводилось усім пацієнтам. Результати: пацієнти з ХСН з ІМ в анамнезі мали достовірно вищий рівень ММP-2, ММР-9 на 21,8% та 20,7% відповідно (р<0,05). Рівні CРП та лейкоцитів були достовірно вищими в пацієнтів 1-ї групи (р<0,05). Достовірні відмінності рівней ММП-2, ММP-9 встановлені в пацієнтів з перенесеним ІМ у різних вікових групах (р<0,05). Рівень MMP-2 позитивно корелював з рівнем MMP-9 (R=0,73, p<0,05), рівень ММР-9 – з віком (R=0,68, р<0,05). Встановлені достовірні відмінності між рівнем галектину-3 серед пацієнтів різного віку (p<0,05). Висновок: сироваткові рівні MMP-2, MMP-9, CРП та галектину-3 були достовірно вищі у хворих з постінфарктною серцевою недостатністю зі збереженою фракцією викиду порівняно з пацієнтами без інфаркту міокарда в анамнезі

Levels of Galectin-3, Advanced Glycated End-Products in Serum, Endothelial Function and Cardiac Hemodynamics in Post Infarction Heart Failure in Patients with Reduced and Preserved Ejection Fraction

Epidemiological studies have reported that the rate of signs and symptoms of heart failure after myocardial infarction is approximately 25%. In addition, approximately 40% of myocardial infarctions are accompanied by left ventricular systolic dysfunction. Aim.. Aim of the study is to evaluate serum levels of galactin-3, AGEs and endothelial function, cardiac hemodynamics in post infarction chronic heart failure patients with different ejection fraction. Materials and methods. All patients are divided into two main groups according to ejection fraction:1st group-20 patients with chronic heart failure with preserved ejection fraction, 2nd group-15 patients with chronic heart failure and reduced ejection fraction. Standard laboratory blood tests for erythrocyte sedimentation rate, haematological parameters, lipid profile, glucose, renal function, echocardiographic examination, endothelial function determine were performed for all patients. AGEs and galectin-3 serum levels were determined. Results. Patients with chronic heart failure and reduced ejection fraction and myocardial infarction in anamnesis had significantly increased left ventricle diastolic volume, left ventricle systolic volume,left ventricle diastolic dimension and left ventricle systolic dimension (p<0.05).AGEs serum level mildly increased in both groups.Galectin-3 level was significantly higher in pts with chronic heart failure and reduced ejection fraction(p < 0.05)and was correlated with age(R=0.74, p<0.05), left ventricle end diastolic volume (R=0.57, p<0.05), left ventricle end diastolic dimension (R=0.48, p<0.05), triglycerides level (R=0.45, p < 0.05). Most of the patients with chronic heart failure with myocardial infarction in anamnesis had endothelial dysfunction, the FMD% level was significantly higher in patients with preserved ejection fraction(p<0.05). Conclusions. Patients with chronic heart failure and reduced ejection fraction are characterized by significantly higher levels of galectin-3, endothelial dysfunction frequency, cardiac hemodynamics abnormalities. Епідеміологічні дослідження свідчать, що симптоми серцевої недостатності після перенесеного інфаркту міокарда мають місце приблизно в 25% хворих. Крім того, приблизно 40% інфарктів міокарда супроводжуються систолічною дисфункцією лівого шлуночка. Мета дослідження – оцінити рівень галектину-3, AGE в сироватці крові та ендотеліальну функцію, серцеву гемодинаміку в пацієнтів із хронічною серцевою недостатністю після інфаркту з різною фракцією викиду. Матеріали та методи. 35 хворих з хронічною серцевою недостатністю на тлі перенесеного інфаркту міокарда віком від 40 до 80 років були включені в дослідження. Пацієнти були розподілені на дві основні групи: 1-а група - 20 пацієнтів із хронічною серцевою недостатністю зі збереженою фракцією викиду, 2-а група - 15 пацієнтів із хронічною серцевою недостатністю зі зниженою фракцією викиду. Виконано стандартні лабораторні аналізи крові з визначенням гематологічних параметрів, ліпідного профілю, глюкози, функції нирок, ехокардіографічне обстеження, визначення функціонального стану ендотелію. Визначено рівні AGEs та галектину-3 у сироватці крові. Результати. Пацієнти із хронічною серцевою недостатністю та зниженою фракцією викиду на тлі перенесеного інфаркту міокарда в анамнезі мали достовірно вищі показники кінцевого діастолічного об'єму лівого шлуночка, кінцевого систолічного об'єму лівого шлуночка, кінцевого діастолічного розміру лівого шлуночка та кінцевого систолічного розміру лівого шлуночка (р<0,05). Рівень AGE у сироватці крові був помірно збільшеним в обох групах. Встановлено достовірно вищий рівень галектину-3 у хворих з хронічною серцевою недостатністю зі зниженою фракцією викиду (p<0,05), що корелює з віком (R=0,74, <0,05), кінцевим діастолічним об'ємом лівого шлуночка (R=0,57, р<0,05)), кінцевим діастолічним розміром лівого шлуночка (R=0,48, р<0,05), рівнем тригліцеридів (R=0,45, р<0,05). Більшість пацієнтів з хронічною серцевою недостатністю з інфарктом міокарда в анамнезі мали ендотеліальну дисфункцію, рівень ендотелійзалежної вазодилятації був достовірно вищим у пацієнтів зі збереженою фракцією викиду (р<0,05). Висновки. Хворі із хронічною серцевою недостатністю та зниженою фракцією викиду характеризуються достовірно вищим рівнем галектину-3, підвищеною частотою ендотеліальної дисфункції, порушень серцевої гемодинаміки

Serum matrix metalloproteinase-2,9 activity, galectin-3 and systemic inflammation in patients with postinfarction heart failure with preserved ejection fraction.

The available data suggest that heart failure (HF) after myocardial infarction (MI) is a very frequent event. Recent meta-analysis showed that restrictive mitral filling pattern, the most severe form of diastolic dysfunction, was presented in approximately 10% of the patients with preserved ejection fraction. In addition, restrictive pattern was associated with poor outcome. However, the true prevalence and relevance of diastolic dysfunction after MI remains to be elucidated. Objective: study was designed to evaluate the serum level of MMP-2,9, galactin-3 and C-reactive protein (C-RP) in postinfarction heart failure with preserved ejection fraction (HFpEF) patients. Methods: We divided all included patients into two main groups: 1st group – 20 patients with HFpEF and history of myocardial infarction. 2nd group – 18 patients with HFpEF and stable angina. Standard laboratory blood tests for erythrocyte sedimentation rate (ESR), C-RP, haematological parameters, lipid profile, glucose, renal and liver function tests were performed and calculated body mass index (BMI) for all patients. MMP activity assay and galectin-3 serum level was detected for all patients. Results: It was established significant differences between study groups in MMP-2, MMP-9 levels. Particularly, patients with HFpEF with MI in anamnesis had significantly higher MMP-2, MMP-9 levels on 21.8% and 20.7% respectively. The C-RP and leucocytes levels were significantly higher in 1st group pts. Significant differences in MMP-2, MMP-9 were established in 1st group patients in different age groups (p&lt;0.05) (tab. 3). The MMP 2 level was positively correlated with MMP 9 level (R=0.73, p&lt;0.05), the MMP 9 level – with age (R=0.68, p&lt;0.05). There were no significant differences between galectin-3 level in study group. But we estimated significant differences in galectin-3 level between 1st and 2nd subgroups (p&lt;0.05). Conclusion: Serum MMP-2, MMP-9, CRP and galactin-3 were significantly increased in pts with postinfarction heart failure with preserved ejection fraction compare to pts without myocardial infarction in anamnesis

Galectin-3, advanced glycated end-products serum levels, endothelial function and cardiac hemo¬dynamics in post infarction heart failure patients with reduced and preserved ejection fraction.

Epidemiological studies have reported that the rate of signs and symptoms of heart failure after myocardial infarction is approximately 25%. In addition, approximately 40% of myocardial infarctions are accompanied by left ventricular systolic dysfunction. Aim.. Aim of the study is to evaluate serum levels of galactin-3, AGEs and endothelial function, cardiac hemodynamics in post infarction chronic heart failure patients with different ejection fraction. Materials and methods. All patients are divided into two main groups according to ejection fraction:1st group-20 patients with chronic heart failure with preserved ejection fraction, 2nd group-15 patients with chronic heart failure and reduced ejection fraction. Standard laboratory blood tests for erythrocyte sedimentation rate, haematological parameters, lipid profile, glucose, renal function, echocardiographic examination, endothelial function determine were performed for all patients. AGEs and galectin-3 serum levels were determined. Results. Patients with chronic heart failure and reduced ejection fraction and myocardial infarction in anamnesis had significantly increased left ventricle diastolic volume, left ventricle systolic volume,left ventricle diastolic dimension and left ventricle systolic dimension (p&lt;0.05).AGEs serum level mildly increased in both groups.Galectin-3 level was significantly higher in pts with chronic heart failure and reduced ejection fraction(p &lt; 0.05)and was correlated with age(R=0.74, p&lt;0.05), left ventricle end diastolic volume (R=0.57, p&lt;0.05), left ventricle end diastolic dimension (R=0.48, p&lt;0.05), triglycerides level (R=0.45, p &lt; 0.05). Most of the patients with chronic heart failure with myocardial infarction in anamnesis had endothelial dysfunction, the FMD% level was significantly higher in patients with preserved ejection fraction(p&lt;0.05). Conclusions. Patients with chronic heart failure and reduced ejection fraction are characterized by significantly higher levels of galectin-3, endothelial dysfunction frequency, cardiac hemodynamics abnormalities

Frequency of risk factors of cardiovascular diseases and renal functional state in patients with chronic heart failure with atrial fibrillation.

There are presented and analyzed the most common and important risk factors (RF) in patients with chronic heart failure and atrial fibrillation (AF). The data indicate the need for more careful attention to this group of patients and the need in early diagnosis of AF RF and their active modification, which is very important for the development of effective measures both for the primary prevention of AF and prevention of progression of this disease

Clinical pattern of systemic sclerosis in Central Ukraine. Association between clinical manifestations of systemic sclerosis and hypertension

Objectives: Systemic sclerosis (SSc) is a rare disease of connective tissue, manifestations of which may vary in different geographical areas. We aimed to describe the clinical portrait of patients with SSc in Dnipropetrovsk region and to investigate how initial clinical and laboratory characteristics are connected with the presence of hypertension in SSc onset. Material and methods: Patients were enrolled to this study from the registry of SSc patients, established in the Rheumatology Department, Mechnikov Dnipropetrovsk Regional Clinic, Dnipro. Thisregistry contains histories of new cases of SSc from 1993 to 2014. Patients are followed-up and receive treatment according to EULAR and local standards. Diagnosis of SSc was based on ACR and EULAR Criteria for systemic Sclerosis. Two patients developed scleroderma renal crisis during follow-up. This report is a cross-sectional study. We analysed only data of the first visit to a rheumatologist. Results: In total 148 patients (median age [IQR] – 47 [40; 52] years) fulfilled the inclusion criteria. Male/female ratio was 1 : 20.1. The most frequent clinical signs were Raynaud’s phenomenon and arthritis. The prevalence of skin lesion in dcSSc patients was twice as high as in lcSSc patients. Pulmonary fibrosis occurred significantly more commonly in dcSSc patients. Hypertension occurred in 26–33% in both groups. Patients with hypertension at the SSc onset were seven years older than normotensive patients. More hypertensive patients were classified as lcSSc. Mean GFR was dramatically lower in hypertensive patients. Conclusions: The most common clinical form in our study was diffuse cutaneous subset of SSc. Hypertension in patients with SSc may be associated with local cutaneous subset of SSc and renal impairment. The strongest predictors of clinical form of SSc are signs of fibrosis (skin lesion and pulmonary fibrosis) and inflammation (arthritis and elevated CRP)