Connection between the effectiveness of ankylosing spondylitis treatment and the state of bone tissue metabolism

Abstract

The aim of the study – to evaluate the effectiveness of pathogenetic therapy in patients with ankylosing spondylitis (AS) and the prognostic value of the initial levels of osteoassociated hormones and chemical elements in hair and blood.

Materials and methods. 79 patients with AS (95 % of men and 5 % of women at the age of 38.3 ± 1.3 years) were under observation. The duration of the clinical manifestation was 11.4 ± 0.8 years, the I degree of the disease activity was detected in 32 % of the cases, II – 39 %, III – 29 %, seropositivity for HLA-B27 was diagnosed in 88 % of the surveyed, for antibodies to cyclic citrulline peptide – in 3.6 % of cases, for rheumatoid factor – in 6.3 % of cases. Osteodeficiency in the form of osteopenia and osteoporosis occurred in 49 % of AS observations. Patients were examined with two-energy X-ray osteodensitometry of the proximal femoral part. Blood levels of parathyroid hormone (PH), osteocalcin (OC), calcitonin (CT) and alkaline phosphatase (AP) were studied in blood. Osteoassociated chemical elements (Ca, Co, Cu, Fe, Li, Mg, Mn, P, Pb, Sr, Zn) were estimated in blood and hair.

Results. There was no effect of the treatment in 4% of the patients, the mild improvement was detected in 21% of the examined patients, the improvement – in 70 %, significant improvement – in 4 %. In AS, there is an increase in the content of PH, OC and the activity of AP in blood with decrease of CT, which is accompanied by increase in Li, Mg, Pb and Sr concentrations in blood with decrease in Ca, Fe, Mn, P parameters. In hair, the level of Pb increases with the inhibition of Ca, Co, Li and Sr, the indices of which correlate with PH, OC, CT and AP, relate to the degree of disease activity, the severity of bone-destructive joint changes and the presence of extraarticular (systemic) signs of the autoimmune process. The initial indices in blood of PT, Co and Mg and in hair of Ca, Fe, Mg, Mn, P, Pb and Sr influence on the effectiveness of pathogenetic medicamentous basic treatment of AS patients. Sulfasalazine and leflunomide play a part in the integral dynamics of bone metabolism parameters, which, along with the parallel prescription of calcemin and ranelate Sr, affect the overall elemental compound of the organism. Under the influence of complex pathogenetic basis therapy, Ca concentration in blood increases and Mg content in hair decreases, and against the background of the additional prescription of calcemin and ranelate Sr, the level of Sr is restored in hair. The combined use of calcemine and ranelate Sr is necessery to all AS patients with osteodeficiency (osteoporosis, osteopenia). Prognostically favorable criteria for the subsequent pathogenetic basis therapy of the disease can be Mg concentration in blood <20 mg / l, and in hair >250 μg / g, while the blood level of the PH >60 pg / ml is a prognosis negative factor in the effectiveness of further treatment.

Conclusions. The effectiveness of basic therapy in patients with AS depends on the initial state of bone metabolism. The presented data will allow to improve the quality of medical technology in the future for early diagnosis and predicting the further course of individual manifestations of the disease, to optimize the nature of rehabilitation activities in patients with osteopenia/osteoporosis, to improve control over the effectiveness of treatment.