DIAGNOSTIC VALUE OF SYSTEMIC LUPUS ERYTHEMATOSUS CLASSIFICATION CRITERIA (AMERICAN COLLEGE OF RHEUMATOLOGY, 1997)

The criteria for the classification of systemic lupus erythematosus were proposed in 1971 by the American College of Rheumatology. They have been clarified since then, but need to be revised.Objective. To determine the diagnostic value of the criteria for the classification of systemic lupus erythematosus proposed by the American College of Rheumatology.Materials and methods. 370 patients (331 women (89.46%) and 39 men (10.54%), average age 41.24 ± 0.63 years) with SLE and 234 patients (150 women (64.10%) and 84 men (35.90%), average age 48.82 ± 0.85 years) with other rheumatic diseases (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis) were randomly enrolled into the study. The patients had undergone comprehensive clinical-laboratory and instrumental examinations in 2010–2018 before they received treatment. The analysis was conducted in MS Excel and SPSS by constructing contingency tables and calculating indicators of diagnostic value.Results. We identified the following criteria as those that can with statistical significance predict the presence of systemic lupus erythematosus: butterfly rash, photosensitivity, serositis (pleuritis, pericarditis), neurologic disorders (seizures, psychosis), thrombocytopenia, renal disorders (proteinuria, cylindruria), anti-dsDNA and antinuclear antibodies.The criteria for the classification of systemic lupus erythematosus were proposed in 1971 by the American College of Rheumatology. They have been clarified since then, but need to be revised.Objective. To determine the diagnostic value of the criteria for the classification of systemic lupus erythematosus proposed by the American College of Rheumatology.Materials and methods. 370 patients (331 women (89.46%) and 39 men (10.54%), average age 41.24 ± 0.63 years) with SLE and 234 patients (150 women (64.10%) and 84 men (35.90%), average age 48.82 ± 0.85 years) with other rheumatic diseases (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis) were randomly enrolled into the study. The patients had undergone comprehensive clinical-laboratory and instrumental examinations in 2010–2018 before they received treatment. The analysis was conducted in MS Excel and SPSS by constructing contingency tables and calculating indicators of diagnostic value.Results. We identified the following criteria as those that can with statistical significance predict the presence of systemic lupus erythematosus: butterfly rash, photosensitivity, serositis (pleuritis, pericarditis), neurologic disorders (seizures, psychosis), thrombocytopenia, renal disorders (proteinuria, cylindruria), anti-dsDNA and antinuclear antibodies

COMPLAINTS OF THE PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND ACTIVE CYTOMEGALOVIRUS AND EPSTEIN-BARR VIRUS INFECTION; THEIR DIAGNOSTIC VALUE

Actuality. The infection with cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in the patients with systemic lupus erythematosus (SLE) is of particular interest to researchers. SLE is a chronic autoimmune disease of unknown etiology that is characterized by multisystemic lesions and is potentially life-threatening [1, 2, 3]. The severity of the problem is caused by the fact that active viral infection can change the manifestations of SLE, but these changes are not always specific, so primary care physicians have no reason to suspect active virus infection at the first stage of examination of SLE patients and prescribe expensive direct virological tests accordingly. It has not been definitively established yet which complaints are the most meaningful regarding the presence of active viral infection in patients with SLE.The purpose of the research was to study complaints in SLE patients with active cytomegalovirus and Epstein-Barr virus infection and determine their diagnostic value. Materials and methods. We randomly enrolled 120 SLE patients – 15 men (12.50%) and 105 women (87.50%) aged 18 to 69 years. All patients received treatment at the Rheumatology Department of Lviv Regional Clinical Hospital in 2014-2019. The diagnosis of SLE was established based on the diagnostic criteria of the American College of Rheumatologists (ACR, 1997). In addition, IgM and IgG antibodies to serum viruses were detected for the diagnosis of CMV and EBV infection. To confirm the presence of active viral infection, viruses were detected in media (CMV - urine, blood; EBV - oral mucosa, blood) by polymerase chain reaction, resulting in 28 patients with SLE (23.33%) detected active CMV infection, in 21 patients with SLE (17.50%) - active EBV infection and in 15 patients with SLE (12.5%) - a combination of active CMV and EBV infection. To achieve the purpose of the study, we identified three steps: the first step was to analyze complaints in patients with SLE with active CMV infection and determine their diagnostic value, the second - in the analysis of complaints in patients with SLE with active EBV infection and clarify their diagnostic values and the third - in the analysis of complaints in patients with SLE with a combination of active CMV and EBV infection and clarification of their diagnostic value. We identified three steps: the first step was to analyze complaints in patients with SLE with active CMV infection and determine their diagnostic value, the second - in the analysis of complaints in patients with SLE with active EBV infection and clarify their diagnostic values and the third - in the analysis of complaints in patients with SLE with a combination of active CMV and EBV infection and clarification of their diagnostic value.Statistical analysis was performed by calculating the chances of establishing the phase of CMV and EBV infection in patients with SLE, using a separate feature - a marker that can be detected during the initial examination of the patient. The probable probability of active infection was determined using indicators of sensitivity, specificity and accuracy [4]. The actual material was processed on a personal computer in MS Excel and SPSS on the basis of conjugation tables with calculation of diagnostic value indicators. The association between active infection and a particular patient complaint was considered to be confirmed when the coefficient of association exceeded 0.5 (or 0.3 for the coefficient of contingency). Research results. It was found that in patients with SLE the presence of active cytomegalovirus infection among the main complaints significantly more often indicate the presence of myalgias (coefficient of association 0.79) or fever (0.51), or chills of the extremities (0.51), or arthralgia (coefficient of contingent 0.31). The presence of active virus Epstein - Barr infections are significantly more often evidenced by the presence of myalgias (coefficient of contingent 0.31) or sleep disorders (coefficient of association 0.84), or mood swings (0.74), or fever (0.61), or the appearance of new rashes (0.53). On the presence of a combination of active cytomegalovirus and virus Epstein - Barr infections significantly more often indicate complaints of sleep disturbances (coefficient of association 0.97) or mood swings (0.83), or a feeling of dryness in the eyes (0.51), or fever (0.50). Conclusions. The presence of active cytomegalovirus infection in patients with systemic lupus erythematosus among the main complaints often indicates the presence of myalgias or fever, or chills of the extremities, or arthralgia, the presence of active virus Epstein - Barr infection - myalgia or sleep disturbances, or mood swings, or fever, or the appearance of new rashes, the presence of their combination - sleep disturbances or mood swings, or a feeling of dryness in the eyes, or fever, which can be used in the diagnostic algorithm. The established patterns of complaints allow us to reasonably suspect in patients with systemic lupus erythematosus the presence of active cytomegalovirus and Epstein-Barr virus infection, the final verification of which requires the use of direct serological tests.Actuality. The infection with cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in the patients with systemic lupus erythematosus (SLE) is of particular interest to researchers. SLE is a chronic autoimmune disease of unknown etiology that is characterized by multisystemic lesions and is potentially life-threatening [1, 2, 3]. The severity of the problem is caused by the fact that active viral infection can change the manifestations of SLE, but these changes are not always specific, so primary care physicians have no reason to suspect active virus infection at the first stage of examination of SLE patients and prescribe expensive direct virological tests accordingly. It has not been definitively established yet which complaints are the most meaningful regarding the presence of active viral infection in patients with SLE.The purpose of the research was to study complaints in SLE patients with active cytomegalovirus and Epstein-Barr virus infection and determine their diagnostic value. Materials and methods. We randomly enrolled 120 SLE patients – 15 men (12.50%) and 105 women (87.50%) aged 18 to 69 years. All patients received treatment at the Rheumatology Department of Lviv Regional Clinical Hospital in 2014-2019. The diagnosis of SLE was established based on the diagnostic criteria of the American College of Rheumatologists (ACR, 1997). In addition, IgM and IgG antibodies to serum viruses were detected for the diagnosis of CMV and EBV infection. To confirm the presence of active viral infection, viruses were detected in media (CMV - urine, blood; EBV - oral mucosa, blood) by polymerase chain reaction, resulting in 28 patients with SLE (23.33%) detected active CMV infection, in 21 patients with SLE (17.50%) - active EBV infection and in 15 patients with SLE (12.5%) - a combination of active CMV and EBV infection. To achieve the purpose of the study, we identified three steps: the first step was to analyze complaints in patients with SLE with active CMV infection and determine their diagnostic value, the second - in the analysis of complaints in patients with SLE with active EBV infection and clarify their diagnostic values and the third - in the analysis of complaints in patients with SLE with a combination of active CMV and EBV infection and clarification of their diagnostic value. We identified three steps: the first step was to analyze complaints in patients with SLE with active CMV infection and determine their diagnostic value, the second - in the analysis of complaints in patients with SLE with active EBV infection and clarify their diagnostic values and the third - in the analysis of complaints in patients with SLE with a combination of active CMV and EBV infection and clarification of their diagnostic value.Statistical analysis was performed by calculating the chances of establishing the phase of CMV and EBV infection in patients with SLE, using a separate feature - a marker that can be detected during the initial examination of the patient. The probable probability of active infection was determined using indicators of sensitivity, specificity and accuracy [4]. The actual material was processed on a personal computer in MS Excel and SPSS on the basis of conjugation tables with calculation of diagnostic value indicators. The association between active infection and a particular patient complaint was considered to be confirmed when the coefficient of association exceeded 0.5 (or 0.3 for the coefficient of contingency). Research results. It was found that in patients with SLE the presence of active cytomegalovirus infection among the main complaints significantly more often indicate the presence of myalgias (coefficient of association 0.79) or fever (0.51), or chills of the extremities (0.51), or arthralgia (coefficient of contingent 0.31). The presence of active virus Epstein - Barr infections are significantly more often evidenced by the presence of myalgias (coefficient of contingent 0.31) or sleep disorders (coefficient of association 0.84), or mood swings (0.74), or fever (0.61), or the appearance of new rashes (0.53). On the presence of a combination of active cytomegalovirus and virus Epstein - Barr infections significantly more often indicate complaints of sleep disturbances (coefficient of association 0.97) or mood swings (0.83), or a feeling of dryness in the eyes (0.51), or fever (0.50). Conclusions. The presence of active cytomegalovirus infection in patients with systemic lupus erythematosus among the main complaints often indicates the presence of myalgias or fever, or chills of the extremities, or arthralgia, the presence of active virus Epstein - Barr infection - myalgia or sleep disturbances, or mood swings, or fever, or the appearance of new rashes, the presence of their combination - sleep disturbances or mood swings, or a feeling of dryness in the eyes, or fever, which can be used in the diagnostic algorithm. The established patterns of complaints allow us to reasonably suspect in patients with systemic lupus erythematosus the presence of active cytomegalovirus and Epstein-Barr virus infection, the final verification of which requires the use of direct serological tests

Dependence of Indicators of Daily Blood Pressure Monitoring on Activity of Pathological Process in Patients with Systemic Lupus Erythematosus

Introduction. It is known that the course of systemic lupus erythematosus (SLE) is often accompanied by the syntropic lesions of the cardiovascular system, among which hypertension has a significant role. Being an important risk factor for the emergence and growth of the severity of syntropic cardiovascular complications in patients with SLE, especially in its active phase, hypertension often impairs their quality of life, and at times is the main cause of death. The purpose of the study is to discover the dependence of the parameters of daily blood pressure monitoring (DMAT) on the pathological process activity in patients with SLE. In order to achieve this objective our goals were to evaluate the following DMAT parameters in SLE patients depending on the pathological process activity: 1) blood pressure in SLE patients during the period of 24 hours; 2) blood pressure in SLE patients during the active and passive periods. Materials and research methods. In a rheumatology centre of Danylo Halytsky Lviv National Medical University at Lviv regional clinical hospital in a randomized manner were examined 83 patients (71 women and 12 men aged 17­68) diagnosed with SLE, who afterwards were stratified into three groups according to the pathological process at the time of DMAT: with the activity of degree I (25 women and 5 men, average age 42,9 ± 2,1 years, with the activity of degree II (33 women and 6 men, the average age 37.9 ± 1,8 years), with the activity of degree III (13 women and 1 men, average age 37.9 ± 1,8 years). The control group consisted of 35 practically healthy individuals of the same sex and age. DMAT was performed with the use of the apparatus ABPM-04 (company “Meditech”, Hungary), the monitor was being activated every 15 minutes during the daytime (from 6 a.m. till 9:59 p.m.) and every 30 minutes during the nighttime (from 10 p.m. till 5:59 a.m.). According to the first goal was rated the BP in the SLE patients during the period of 24 hours, for which: a) were examined the average daily, maximum and minimum levels of systolic blood pressure (SBP), diastolic blood pressure (DBP), the average blood pressure; b) was analysed the daily index (DI) of SBP, DBP and the average blood pressure; c) was examined the time index (TI) of SBP, DBP and the average blood pressure. According to the second goal was rated the blood pressure in SLE patients during the active and passive periods, for which: a) were examined the average daily, maximum and minimum levels of SBP, DBP, the average blood pressure during the active period; b) were examined the average daily, maximum and minimum levels of SBP, DBP, the average blood pressure during the passive period; c) was studied the TI of SBP, DBP and the average blood pressure during the active and passive periods. Were compared the DMAT indices in patients with different degrees of activity of SLE: patients with the SLE activity of degree I were compared with the patients with the SLE activity of degree II and III, patients with the SLE activity of degree II were compared with the patients with the SLE activity of degree III. The actual material was processed on a PC with the help of Microsoft Excel using descriptive statistics and Student’s t-test in order to compare the samples with a normal distribution. For all the examined patients were applied the principles of the Helsinki Declaration of Human Rights, the European Convention on Human Rights and Biomedicine. Results of the investigation and their discussion. After the indices of blood pressure in patients with SLE were compared during the day in general, was stated the availability of the increase of blood pressure with the increase of the degree of the SLE activity on almost all indicators (except the maximum DBP). This pattern of the consistent growth, depending on the severity of the disease, was proved by the results of average estimation of daily SBP, minimum SBP, average daily DBP, minimum DBP, daily and minimum average blood pressure. Of all the indicators which are characterized by the increase of blood pressure in patients with the SLE with the activity of degree II compared with patients with the SLE with the activity of degree III, the indices of average SBP are accurate. The most convincing information, that truly confirms the increase of blood pressure with the increase of the SLE activity, was detected in patients of the third group comparing seven out of nine (except the maximum DBP and SBP, the results of which are unreliable) indicators of SBP, DBP and the average blood pressure with the patients of the second (except the maximum SBP, the level of which varies, but not significantly) and the first groups. Since DI is a significant indicator that shows a violation of the circadian rhythm of blood pressure due to its insufficient decline during the night period, the obtained results can be interpreted as a sign that an increase in the activity of SLE increases the severity of a violation of circadian rhythm changes in blood pressure with a decrease in the number of patients with preserved physiological rhythm, increase of the deficit of blood pressure reduction during a passive period and the increase in the number of the so-called “night-peakers” patients with the phenomenon of “non-dipper”, which may indicate a malignant course of hypertension, the presence of its symptomatic form and is considered to be an independent risk factor of cardiovascular complications. The obtained results of TI studies show, that with the increase of the SLE severity the frequency of episodes in which the blood pressure exceeded the permissible limits, was increasing. All the nine indicators, that characterize the blood pressure during the active period, investigated in patients with I, II and III levels of activity, increased naturally (except the maximum DBP in the third group) with the increase of the degree of SLE activity, and the most directly-proportional dependence of the increase of the severity of disease and the value of the investigated parameters is observed in the III group patients compared with the II and especially the I group patients. All the nine indicators, that characterize the blood pressure during the passive period, investigated in patients with I, II and III levels of activity, increased naturally with the increase of the degree of SLE activity, and the most directly-proportional dependence of the increase of the severity of disease and the value of the investigated parameters is observed in the III group patients compared with the II and especially the I group patients. Out of the six parameters of TI in patients of the three groups only the SBP TI was below the reference parameters in patients of the first group with the SLE activity of degree I during the active period and all three indices in patients within this group (SBP, DBP and the average blood pressure) are higher during the passive period than during the active. All the six indicators characterizing the TI during both active and passive periods naturally increase with increase of the degree of activity of SLE, and most clearly a directly-proportional dependence between the increase of the severity of disease and the value of the investigated parameters is observed in the III group patients compared with the II and especially the I group patients. Conclusions. In patients with SLE the indices of DMAT depend on the activity of the pathological process – the blood pressure increases significantly with its rise on almost all parameters (except the maximum DBP), with the change of the physiological circadian rhythm due to its insufficient decline in the night period and with an increase of frequency of episodes in which the blood pressure exceeds the permissible limits. The identified patterns of changes of DMAT are also preserved throughout the period of 24 hours, and according to the results of their separate evaluation during a nighttime and daytime so that during a passive periods these figures are significantly more often lower than the reference values, especially in patients of first and second groups

Complications of the Gastric Cancer in a Rheumatology Practice: a Literature Review and Clinical Case Study

Introduction. The problem of the diagnosis and treatment of the patients with cancer, in particular, with localization of it in the stomach, is one of the most pressing problems of today, both in Ukraine and throughout the world. The incidence of cancer is traditionally high in many countries, with males being twice as high as women. Annually in the world about 750 thousand new cases of gastric cancer are registered. Ukraine ranks eighth among the 48 countries in the world, which account the oncological diseases, by the indices of cancer. In the structure of mortality from malignant tumors, stomach cancer takes second place as in men (after malignant neoplasms of the lungs) and women (after breast cancer). In 2006, the incidence of stomach cancer in Ukraine was 27.4 per 100 thousand people, which significantly exceeds the world population – 15.6 per 100 thousand population. Aim. To make an overview of modern literature on the complications of gastric cancer in the practice of a doctor-rheumatologist and describe a clinical case. Materials and methods. The content analysis, the method of system and comparative analysis, the bibliosemantic method of study of the actual scientific researches concerning complications of gastric cancer in the practice of the doctor-rheumatologist, and the clinical case have been described. Results. It is presented the clinical case of arthralgic syndrome caused by the remote bone stomach cancer metastases in the practice of the doctor-rheumatologist. Diagnostic algorithm for the patient’s examination, directed by a family doctor with a suspicion of reactive arthritis, in the conditions of a rheumatologic hospital presupposes the use of a number of laboratory tests, most of which are performed in private laboratories. These tests were performed, signs of rheumatologic disease were not detected, but an increase of alkaline phosphatase level in serum by almost 12 times became the reason for reversing the search for the cause of bone tissue damage. X-ray examination of bone: focal changes has not been detected, chest x-ray has suspected metastasis in the lungs. Scintigraphic studies have revealed multiple metastatic bone defects. The ways of optimizing of the diagnosis search in patients with bone pain, elevated levels of alkaline phosphatase and burdened oncological history are outlined. It is noted that the optimal and most rational method of diarrhea in these situations is to study the level of alkaline phosphatase in the serum of the patient and make the scintigraphy with 99mTc-MDP. Conclusions. Taking into account the practical rheumatology, the article focuses on the optimal diagnosis of the patients experiencing pain in the bones, having the elevated levels of alkaline phosphatase, and the patients burdened with a cancer anamnesis. The studies on the problem show that the most effective and rational diagnostic method of gastric cancer is 99mTc-MDP scintigraphy

Сomparative Evaluation of Bone Mineral Density Based upon the Results of Ultrasound Osteodensitometry, X-ray Osteodensitometry, and Dual-Energy X-ray Absorptiometry Tests in Premenopausal Women with Systemic Lupus Erythematosus

Introduction. Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the chronic inflammation and multisystemic damages, accompanied by lesions in osteoarticular system, including secondary osteoporosis (OP) ­ an important risk factor for low­energy fractures. The most common noninvasive osteoporosis tests currently in use in Ukraine include ultrasound densitometry and X­ray densitometry (dual­energy X­ray absorptiometry (DXA) and hand bone X­ray densitometry). The objective is to compare diagnostic values of bone mineral density tests that employ ultrasound densitometry, X­ray osteodensitometry, and dual­energy X­ray absorptiometry in premenopausal women with SLE. Materials and methods. The study randomly included 51 women aged between 21 and 53 (mean age at the time of the study – 38.21 ± 1.66) which were diagnosed with SLE according to the criteria of the American College of Rheumatology (1982, 1997); all women at the time of the study were premenopausal. 100.0 % of the patients received methylprednisolone at a dose of 4.0 to 24.0 mg/day (average dose – 11.12 ± 0.81 mg/day) and calcium supplements at a dose of 1000.0 mg/day in combination with vitamin D at a daily dose of 400.0 IU. The average duration of treatment with glucocorticoids and calcium supplements corresponded to the average disease duration. Bone mineral density was assessed through calcaneus ultrasound bone densitometry performed with SONOST-2000 device (OsteoSys Co., Ltd, Seoul, Korea), hand bone X­ray densitometry performed with “ARM­Osteoloh” application, and dual­energy X­ray absorptiometry of lumbar spine and proximal femur performed with dual­energy X­ray absorptiometer (Stratos, France). Statistical analysis of the obtained results was carried out in MS Excel and IBM SPSS Statistics applications. Results and their discussion. The results of ultrasound densitometry among 51 patients with SLE were as follows: 13 (25.49 %) women were diagnosed with osteoporosis (average T­score ­(­2.77) ± 0.08); 26 (50.98 %) women were diagnosed with osteopenia (average T­score ­ (­1.81) ± 0.08), 6 of them (11.76 %) ­ with the first degree of osteopenia (average T­score ­ (­1.25) ± 0.04), 9 of them (17.65 %) ­ with the second degree of osteopenia (average T­score ­ (­1.74) ± 0.06), 11 of them (21.57 %) ­ with third degree of osteopenia (average T­score ­ (­2.17) ± 0.02); 12 (23.53 %) women had normal BMD (average T­score ­ (­0.7) ± 0.07). The results of hand bone X­ray densitometry among all patients with SLE showed changes in bone mineral density. 20 (39.22 %) women were diagnosed with osteoporosis (average T­score ­ (­3.03) ± 0.08); 23 (45.09 %) women ­ with osteopenia (average T­score ­ (­2.01) ± 0.08), 4 of them (7.84 %) ­ with the first degree of osteopenia (average T­score ­ (­1.2) ± 0.11), 19 of them (37.25 %) ­ with the third degree of osteopenia (average T­score ­ (­2.18) ± 0.03); 8 women (15.69 %) had normal BMD (average T­score ­ (­0.38) ± 0.01). The results of lumbar spine bone density test employing dual­energy X­ray absorptiometry (DXA) were as follows: 16 (31.37 %) patients with SLE were diagnosed with osteoporosis (average T­score ­ (­3.14) ± 0.13); 21 (41.18 %) patients were diagnosed with osteopenia (average T­score ­ (­1.56) ± 0.13), 10 of them (19.61 %) ­ with the first degree of osteopenia (average T­score ­ (­1.14) ± 0.03), 7 of them (13.73 %) ­ with the second degree of osteopenia (average T­score ­ (­1.70) ± 0.07), 4 of them (7.84 %) ­ with the third degree of osteopenia (average T­score ­ (­2.35) ± 0.03); 14 patients (27.45 %) had normal levels of BMD (average T­score ­ (­0.36) ± 0.15). The results of proximal femur bone density test employing DXA were as follows: only 12 (23.53 %) patients with SLE were diagnosed with osteopenia (average T­score ­ (­1.28) ± 0.08), 5 of them (9.80 %) ­ with the first degree of osteopenia (average T­score ­ (­1.03) ± 0.03), 3 of them (5.86 %) ­ with the second degree of osteopenia (average T­score ­ (­1.65) ± 0.04), 4 of them (7.84 %) ­ with the third degree of osteopenia (average T­score ­ (­2.05) ± 0.03); 39 patients (76.47 %) had normal levels of BMD (average T­score ­ (0.2) ± 0.14). The findings demonstrate direct correlation between T­score results obtained by ultrasound heel bone densitometry and T­score results obtained by lumbar spine DXA (r = 0.72, p < 0.001) as well as T­score results obtained proximal femur DXA (r = 0.38, p < 0.05). The findings also indicate direct relationship between the results of BMD tests employing hand bone X­ray densitometry and lumbar spine DXA (r = 0.56, p < 0.001) as well as proximal femur DXA (r = 0.37, p < 0.05). There is also direct correlation between the results of the BMD tests obtained by ultrasound heel bone densitometry and X­ray hand bone densitometry (r = 0.7, p < 0.001). Both ultrasound heel bone densitometry and X­ray hand bone densitometry identified 89.0 % of patients who had lowered BMD levels according to the results of lumbar spine DXA and 100.0 % of patients who had lowered BMD levels according to the results of proximal femur DXA (sensitivity – 0.89 and 0.1 respectively). Ultrasound densitometry demonstrated higher specificity compared to X­ray osteodensitometry: it identified 57.0 % of the patients who had normal BMD levels according to the results of lumbar spine DXA and 31.0 % of the patients who had normal BMD levels according to the results of proximal femur DXA (specificity ­ 0,57 and 0,31 respectively). X­ray osteodensitometry identified 29.0 % of the patients who had normal BMD levels according to the results of lumbar spine DXA and 21.0 % of the patients who had normal BMD levels according to the results of proximal femur DXA (specificity ­ 0,29 and 0,21, respectively). Conclusions. The study demonstrated that both ultrasound heel bone densitometry and X­ray hand bone densitometry are highly sensitive compared to dual­energy X­ray absorptiometry and acceptable methods for diagnosis of osteoporosis in patients with SLE