Clinico-pathogenic aspects of osteodeficiency in osteoarthritis in combination with chronic pancreatitis.

OBJECTIVE: Introduction: Pathology of the musculoskeletal system creates a number of important and complex medical problems affecting the economic situation of society, health and quality of life of individuals and their families. One of these problems and the most common disease of the joints which is diagnosed in 20% of the population of the planet is osteoarthritis (OA). The aim: The article deals with modern views on the problem of comorbidity of osteoarthritis, chronic pancreatitis and osteodefiсiency. Dual energy X-ray densitometry data were analyzed, as well as indicators of activation of lipid peroxidation (malonic aldehyde), antioxidant protection system (superoxide dismutase and SH-group, ceruloplasmin, сatalase) and tissue destruction (oxyproline). PATIENTS AND METHODS: Materials and Methods:The complex examination of 72 patients was made. Patients were divided into two groups: 30 patients with OA and 42 - with OA in combination with CP. The control group included 20 apparently healthy individuals. Evaluation of CT scan was performed using Dual Energy X-Ray Absorptiometry - DXA by Lunar corp. (Madison, WI) - Lunar DPX-A No. 2589 in the lumbar region of the vertebral column. The evaluation of the indicators was carried out in accordance with WHO recommendations (WHO, Geneva, 1994) [1]. The study of LPO was carried out on the level of malonic aldehyde (MA). To assess AOP, we determined SOD, ceruloplasmin (CPN); SH-groups; catalase. The endogenous intoxication and the level of degradation of the connective tissue in the body was estimated by levels of free oxyproline. The influence of CP on the state of LPO-AOP was established by the following clinical characteristics of CP: age of the patients, structural condition of the pancreas with the help of the method of ultrasound, expressed in points. Excretory function of the pancreas was investigated on the level of fecal α-elastase ( by ELISA test using the kits BIOSERV ELASTASE 1-ELISA). RESULTS: Results: During the examination of the mineral bone density by the dual energy X-ray densitometry it was discovered that the presence of CP in patients with OA led to a significant reduction of BMD and deterioration of the bone tissue (BT): the proportion of patients with normal bone decreased from 67% to 16%, the number of patients with osteopenia increased from 10% to 67%; patients with OP appeared - 17%.Besides, the increased degradation of bone tissue in OA with CP was accompanied by strengthening of oxidative changes (by MA-level), weakening of the antioxidant defense (SOD and SH-groups), the increase in the severity of inflammation and endotoxemia (levels of catalase and ceruloplasmin), as well as increased degradation of connective and bone tissue in the joints and progression of fibrosis in tissue (the level of oxyproline). CONCLUSION: Conclusions: It was found out that the presence of CP in patients with OA led to a significant reduction of BMD and the deterioration of the bone tissue. It was discovered that during the combined course of OA and CP with osteopenia there occurs the weakening of the AOP (by SOD and SH-groups) and a relatively high level of LPO activation (by MAlevel) as well as the increased deterioration in connective and bone tissue and aggravation of osteopenia which is indicated by the increased levels of oxyproline.