Method for predicting osseous fractures in rheumatoid arthritis-suffering women

FIELD: medicine, therapy, rheumatology.

SUBSTANCE: one should detect mineral density of bony tissue in lumbar vertebral department, in column femoris; from patient's life anamnesis one should detect risk factors for osseous fractures: duration of menopause, duration and index of disease severity degree, systemic manifestations of rheumatoid arthritis (RA), solitude, dosage and duration for the intake of glucocortico-steroid (GCS) preparations to establish their gradations and digital values: no risk factor - the sign has got digital value "0", if risk factor is available - "1". Then it is necessary to detect prognostic coefficients F1 and F2 by the following formulas: F1 = -38.72 - 7.27*X1 + 9.77*X2 + 6.30*X3 +4.25*X4 + 7.41*X5 + 9.66*X6 + 32.97*X7 + 3.62*X8 + 8.96*X9 + 38.04*X10 - 0.55*X11 - 0.50*X12; F2 = -5.41 - 4.32*X1 + 3.22*X2 + 2.91*X3 + 3.28*X4 + 3.24*X5 +3.93*X6 + 7.43*X7 +1.35*X8 + 1.08*X9 + 9.07*x10 - 0.11*X11 - 0.19*X12, where X1-12 - gradations and digital values of risk factors (X1 - age is above 45, X2 - postmenopause is above 5 years, X3 - RA duration is above 10 years, X4 - severity degree index is above 5 points, X5 - RA systemic manifestations, X6 - solitude, X7 - intake of GCS preparations is above 2 years, X8 - cumulative dosage of GCS is above 5000 mg, X9 - mineral density of bony tissue in lumbar vertebral department by T-criterion is below -2.5, X10 - mineral density of bony tissue in collum femoris by T-criterion is below -2.5, X11 - mineral density of bony tissue in collum femoris is below 0.700 g/sq. cm, X12 - mineral density of bony tissue in lumbar vertebral department is below 0.900 g/sq. cm). At F1≥F2 one should predict high risk for fracture possibility, and at F1<F2 - low risk for fracture chance. The innovation enables to take into consideration the sum of common and specific risk factors.

EFFECT: higher accuracy of prediction.

4 ex, 1 tbl

 

The present invention relates to medicine, namely to therapy and rheumatology, and can be used to predict fractures in women with rheumatoid arthritis and no clinical signs of osteoporosis.

Osteoporosis is one of the most common metabolic diseases of the skeleton, which is manifested by a decrease in bone mass and impaired microarchitecture bones, which leads to increased brittleness of the bones and, accordingly, increases the risk of fractures [Guide to osteoporosis. Edited Benevolensky LI - M.: BINOM. Knowledge laboratory, 2003. - P.10].

It is known that among patients with rheumatic diseases, the frequency of osteoporosis is higher. So, J.Hooyman notes that the relative risk of fractures in rheumatoid arthritis increased in 1,5-2,5 times [Hooyman J.R., Melton L.J.III, Nelson A. M., O'fallon W.M., Riggs B.L. Fractures after rheumatoid arthritis: a population-based study. Arthritis Rheum. - 1984. No. 9. - P.1353-1361].

A known method for predicting the development of secondary osteoporosis and bone fractures in women suffering from rheumatoid arthritis, including the identification of risk factors - receiving glucocorticosteroid (GCS) drugs in postmenopausal women [Zotkin EVGENIY Osteoporosis in certain rheumatic diseases: Dis...Dr. med. Sciences: 14.00.05/St. Petersburg Academy of Sciences. the honey. Academ. policyplan. education. M., 2002. - P.113-114].

In this way to OC the NCI impact SCS therapy on the development of compression fractures conduct logistic regression analysis, which showed that the risk of vertebral fractures in women with rheumatoid arthritis who took corticosteroids therapy for more than 12 months, was to 3.67 times higher than in the group of patients who have never taken the SCS.

The disadvantages of this method include the fact that the influence of only one stand-alone risk factor for fractures - admission GCS and not taken into account the interaction between other risk factors.

Closest to the present invention is a method for predicting the development of osteopenic syndrome and bone fractures in patients with rheumatoid arthritis, including ultrasonic measurement of bone density in the calcaneus and the experimental selection of polynomial regression models, reflecting the dynamics of changes in bone mass by T-criterion depending on age [Zotkin EVGENIY Osteoporosis in certain rheumatic diseases: Dis... Dr. med. Sciences: 14.00.05 / St. Petersburg Academy of Sciences. the honey. Academ. policyplan. education. M., 2002 - S-98].

According to who recommendations the diagnosis of osteoporosis was determined by T-test (variance of BMD from peak bone mass in healthy young adults), which should be less of-2.5 SD (standard deviations), osteopenia from 1,0 to SD and 2.5 SD [Guide to osteoporosis. Edited Benevolensky LI - M.: BINOM. Knowledge laboratory, 2003. - S-140]. For Nord who have adopted mineral bone density (BMD) above - 1,0 SD.

The sensitivity of the progression of osteoporosis in this method of forecasting with such risk factors as disease duration of RA, is 63,6%.

The disadvantages of this method include low accuracy of the prediction of the development of bone fractures, because the method is based on the analysis of two risk factors - mineral bone density (BMD) in combination with the woman's age, a patient with rheumatoid arthritis.

The disadvantages of this method should also include the use of ultrasound is called, the accuracy of which is much lower than x-ray. So, the work of a number of authors have shown that the results of ultrasound densitometry of the calcaneus may not be used as a predictor of bone fractures [A. Massie, D.M. Reid et al. Screening for osteoporosis: Comparison between dual energy x-ray absorptiometry and broadband ultrasound attenuation in 1000 perimeno-pausal women.//Osteoporosis Int., 1993; 3: 107-110].

The task of the invention is to develop a predictor of bone fractures in women with rheumatoid arthritis who do not have clinical manifestations of osteoporosis.

The technical result of the proposed method is to improve the accuracy of prediction of the risk of bone fractures in women with rheumatoid arthritis taking into account a set of General and specific risk factors.

the Technical result of the proposed method is achieved by the prediction of bone fractures in women with rheumatoid arthritis (RA), includes the determination of mineral bone density in the calcaneus and the establishment of the age of the patient.

The difference lies in the fact that further define the mineral bone density in the lumbar spine, in the neck of the femur, identify risk factors for fractures of the history of life (duration of menopause, duration and severity index disease, systemic manifestations of RA, loneliness, acceptance, dose and duration of intake glucocorticosteroid (GCS) drugs), establish their grades and numeric values, and then determine the prognostic factors F1and F2by the formulas:

respectively, where X1-12- grades and numerical values of risk factors (X1- age greater than 45 years, X2- more than 5 years postmenopausal, X3- duration RA for more than 10 years, X4the severity index is greater than 5 points, X5- systemic manifestations of RA, X6- loneliness, X7- receiving corticosteroids for more than 2 years, X8- the cumulative dose of corticosteroids more than 5000 mg; X9- mineral bone density in the lumbar spine T - criterion of less -2,5, X10mineral tightly the th bone in the neck of the femur by T-criterion of less -2,5; X11- mineral density of bone tissue in the neck of the femur less 0,700 g/cm2X12- mineral bone density in the lumbar spine less to 0.900 g/cm2). When the numerical values of F1≥F2predict a high risk, and a value of F1<F2- low risk of fracture in women with rheumatoid arthritis who do not have clinical manifestations of osteoporosis.

Comparative analysis of the proposed method and the prototype showed that the proposed method differs from the known fact that to determine the impacts of aggregate both shared with specific due to rheumatoid arthritis, risk factors for fracture: age of women older than 45 years, the duration of postmenopause more than 5 years, duration of rheumatoid arthritis for more than 10 years, the severity index for rheumatoid arthritis more than 5 points, systemic disease, loneliness, the duration of the administration of corticosteroids for more than 2 years, the cumulative dose of corticosteroids for more than 5,000 mg, T-criterion in the L2-L4 less -2,5, T-score at the femoral neck less than - 2.5, the BMD in the femoral neck less 0,700 g/cm2, BMD in L2-L4 less to 0.900 g/cm2.

Establish grades and numerical values of risk factors, then expect prognostic factors F1and F2on visa evidendy formulas. When F1≥F2 predict a high risk of fractures, when F2>F1the risk of fracture is low.

Thus, the proposed solution meets the criteria of the invention of "novelty."

The analysis of patent and literature the authors found that the proposed method has characteristics that distinguish it not only from the prototype, but also other technical solutions in this and related fields of medicine.

In the available literature we found no way of forecasting the development of fractures in rheumatoid arthritis, taking into account the totality of General and specific risk factors.

A set of techniques proposed method can improve the accuracy of the prediction of bone fractures in women with rheumatoid arthritis, by identifying the specific and General risk factors.

Thus, the proposed method meets the criterion of "inventive step".

A method for predicting bone fractures in women with rheumatoid arthritis, comprising the invention, is intended for use in health care. The implementation of its capabilities is confirmed as described in the application techniques and equipment. From the above it follows that the claimed invention meets the condition of patentability "industrial " use the ity".

The proposed method is as follows. According to the results of clinical, laboratory and radiological surveys and life history of the subject patient (rheumatoid arthritis) identify the established risk factors.

The activity of rheumatoid arthritis assessed according to a set of clinical (articular index of joint account) and laboratory signs (erythrocyte sedimentation rate in mm/h, hemoglobin level in g/l) at points [Ivanova N.M., Karataev CU and al. Clinical course variants of rheumatoid arthritis and the choice of method is the drug therapy//Clinical rheumatology. - 1994. No. 4. - S-28].

Radiographic stage of rheumatoid arthritis is determined by the classification of Steinbrocker, functional disorders of the joints are divided into 4 degrees of severity, depending on the ability to self-service, non-professional and professional activities [Rheumatic diseases: a Guide to internal medicine/ edited Vaasanai, Nvenue. - M.: Medicine, 1997. - S-284].

The severity index for rheumatoid arthritis set depending on x-ray stage, functional disability, disease activity, which is assessed in points [Ivanova N.M., Karataev CU and al. Clinical course variants of rheumatoid arthritis and the choice of method is medicamentosas therapy// Clinical rheumatology. - 1994. No. 4. - S-28].

Mineral bone density determined by x-ray two-photon absorptiometry apparatus DPX-JQ" company "Lunar" (USA).

To predict the development of fractures in patients with RA was applied the method of linear discriminant analysis. Using statistical criteria specified analysis revealed the most significant risk factors and determined the coefficients of the discriminant functions [Glanz S. biomedical statistics. 1999. - 459 S.].

As a result, the authors of the proposed method were selected significant features, the most distinguished group of patients with fractures from a group of patients without fractures.

The following table summarizes the characteristics of the signs and the coefficients of the discriminant functions.

The coefficients of the discriminant functions (K1j, K2j) and constants F1=-38.72 and F2=-5.41 established by the authors empirically (table 1).

Table 1
Risk factorsGradingK1jK2j
1. Age > 45 years0-no, 1--7.274.32
2. Post-menopause >5 years0-no, 1-9.773.22
3. Duration PA>10 l is t 0-no, 1-6.302.91
4. The severity index >5 points0-no, 1-4.253.28
5. Consistency PA0-no, 1-7.413.24
6. Loneliness0-no, 1-9.663.93
7. Admission GCS > 2 years0-no, 1-32.977.43
8. The cumulative dose of corticosteroids> mg0-no, 1-3.621.35
9. T-criterion in the L2-L4<-2,50-no, 1-8.961.08
T-criterion in the femoral neck<-2,50-no, 1-38.049.07
NOT in the femoral neck<0,700 g/cm20-no, 1--0.55-0.11
NOT in L2-L4<to 0.900 g/cm20-no, 1--0.50-0.19

F1- for a group of patients with fractures. F2for the group of patients without fractures.

Constant for F1=-38.72; Constant for F2=-5.41.

The results of discriminant equations allow us to predict the development of fractures in women with rewma odnim arthritis.

If the value of F1≥F2that predict a high risk of fractures, when F2>F2the risk of fracture is low.

The proposed method is as follows.

From the anamnesis of life and patient with rheumatoid arthritis identifies the established risk factors. During the inspection determine articular index of joint account. Conduct laboratory studies to determine the level of hemoglobin and erythrocyte sedimentation rate. The apparatus of the digital x-ray graphy conduct examination of patients. On rentgenoradiometricheskim image determine the stage of rheumatoid arthritis according to the classification of Steinbrocker. Using a standardized questionnaire to determine the degree of functional disability. Then together clinical and laboratory data to calculate the severity index for rheumatoid arthritis. Conduct inspection apparatus DPX-JQ" company "Lunar" (USA). Acquired risk factors assign grades and numeric values. Then establish prognostic factors F1and F2compare their numerical characteristics and assess the risk of fractures.

The proposed method for predicting the development of fractures in women with rheumatoid arthritis, illustrated by examples of specific performance.

Example 1.

Patient N. born in 1945 surveyed in the osteoporosis Centre (CSC) in 2002. When interviewing the following risk factors: patient age older than 45 years (X1=l), duration of more than 5 years postmenopause (X2=l), duration of RA for more than 10 years (X3=1), the severity index RA of more than 5 points (X4=1), systemic RA (X5=1), X6=0, taking corticosteroids for more than 2 years, (X7=1), the cumulative dose of corticosteroids for more than 5,000 mg (X8=l), X9=0, the mineral bone density (BMD) T-criterion in the L2-L4 is less than - 2.5 in the neck of the femur (X10=1), BMD in femoral neck bone less 0,700 g/cm2(X11=1). X12=0

F1>F2, the risk of bone fractures is high. In 2003 at the age of 58 in a given patient has been a fracture of the left femur when falling from a height of around two meters.

Example 2.

Patient L., born in 1938 Surveyed in CSC 2002. The following risk factors for fracture: patient age older than 45 years (X1=1), duration of more than 5 years postmenopause (X2=1), duration of RA for more than 10 years (X3=1), the severity index of more than 5 points (X4=1), systemic RA (X5=1), BMD T-criterion in the spine less -2,5 (X9=1), BMD in the spine less to 0.900 g/cm2(X12=1).

F1<F2patient misses a high risk of fractures. With the re-examination in the MDGs and monitoring osteodensitometry in 2003, signs of secondary osteoporosis have been identified.

Example 3.

The patient Was Surveyed in 2001. born in 1950, Established the following risk factors for osteoporosis: patient age over 45 years (X1=1), duration of more than 5 years postmenopause (X2=1), duration of RA for more than 10 years (X3=1), systemic RA (X5=1), loneliness (X6=1), corticosteroids for more than 2 years, (X7=1), BMD T-criterion of less than - 2.5 in the neck of the femur (X10=1), BMD in femoral neck bone less 0,700 g/cm2(X11=1).

Fi>F2the risk of fractures, the patient is high. In 2003, there was a spontaneous fracture of the ribs.

Example 4.

Patient L., born in 1963 Surveyed in 2002. The following risk factors for secondary osteoporosis: a disease duration of more than 10 years, (X3=1), systemic manifestations (X5=1), BMD T-criterion in the spine less -2,5 (X9=1), BMD in the spine less to 0.900 g/cm2(X12=1). X1,2,4,6.7,8,10,11=0

F1<F2the risk of fracture is low. With the re-examination in the MDGs and monitoring osteodensitometry in 2003, signs of secondary osteoporosis have been identified.

Monitoring of patients with RA was carried out in 2000 in the Irkutsk regional center for prevention of osteoporosis. Evaluation of the effectiveness of the proposed method of forecasting was conducted in a group of 126 women, patients with rheumatoid arthritis, the accuracy of prediction was 85.5%. In a group of 58 women with rheumatoid arthritis and secondary osteoporosis correct recognition was 100%.

The proposed method for forecasting allows you to select among patients with rheumatoid arthritis of persons at risk of developing fractures, which makes it possible for individual early treatment and preventive measures. On the basis of the prediction system can be implemented a strategy to prevent the development of secondary osteoporosis and bone fractures in patients with rheumatoid arthritis.

A method for predicting bone fractures in women with rheumatoid arthritis (RA), which includes the determination of bone density and age of the patient, characterized in that further define the mineral bone density in the lumbar spine, in the neck of the femur, sananes life identify the risk factors of fractures: the duration of menopause, the duration and severity index disease, systemic manifestations of RA, loneliness, dose and duration of intake glucocorticosteroid (GCS) drugs, establish their grades and numeric values, namely: there is no risk factor - sign assigns the numeric value "0", "1", and then determine the prognostic factors F1and F2by the formulas:

respectively, where X1-12- grades and numerical values of risk factors, and X1- age greater than 45 years, X2- more than 5 years postmenopausal, X3- duration RA for more than 10 years, X4the severity index is greater than 5 points, X5- systemic manifestations of RA, X6- loneliness, X7- receiving corticosteroids for more than 2 years, X8- the cumulative dose of corticosteroids more than 5000 mg; X9- mineral bone density in the lumbar spine T-criterion of less - 2,5, X10- mineral density of bone tissue in the neck of the femur by T - criterion of less -2,5; X11- mineral density of bone tissue in the neck of the femur less 0,700 g/cm2X12- mineral bone density in the lumbar spine less to 0.900 g/cm2and when F1≥F2predict high risk, and a value of F1<F2 - low risk of fracture.



 

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2 ex, 2 tbl

FIELD: medicine, obstetrics.

SUBSTANCE: the present innovation deals with predicting disadaptive processes in women in dynamics of menstrual cycle. During menstrual cycle beginning since the 1st d to the 21st d one should detect the dynamics for alteration in coefficient of activity of syntoxic adaptation programs (CASAP), calculated by the following formula:

where CST - concentration of blood serotonin, AAT-III - activity of antithrombin III, Aaoa - total antioxidizing activity of plasma, CCD8+ - concentration of T-suppressors, Cad - concentration of blood adrenalin, Cα2MG - concentration of α2-macroglobulin, CMDA - concentration of malonic dialdehyde, CCD4+ - concentration of T-helpers. Moreover, normally CASAP value alters two-fold against the first day of the cycle - since 0.70 up to 1.40 on the 21st d of the cycle, at no alterations in CASAP value one should diagnose female disadaptive alterations leading to failed pregnancy. The innovation enables to perform diagnostics of disadaptive processes in women in dynamics of menstrual cycle followed by prognostic conclusion upon future pregnancy.

EFFECT: higher accuracy of diagnostics.

2 ex

FIELD: medicine, oncourology.

SUBSTANCE: one should choose the number of points for biopsy : 1 point of biopsy/5 cu. cm of an organ, then it is necessary to detect the portion of cancerous parenchyma in bioptates in percentage morphometrically due to analyzing of not less than 1000 points minimum in 5 sections of preparation, the volume of cancerous parenchyma in an organ should be detected by the following formula:

where X - average value for the portion of cancerous parenchyma in an organ, in %; ΣA - the portion of cancerous parenchyma in bioptate in %; N - the number of bioptates. The present innovation enables to detect cancerous parenchyma both in case of interrupted and diffused forms of prostatic cancer.

EFFECT: higher accuracy of detection.

1 dwg, 3 ex

FIELD: medicine, clinical toxicology.

SUBSTANCE: at patient's hospitalization one should gather the data of clinical and laboratory values: on the type of chemical substance, patient's age, data of clinical survey and laboratory values: body temperature, the presence or absence of dysphonia, oliguria being below 30 ml/h, hemoglobinuria, erythrocytic hemolysis, exotoxic shock, glucose level in blood, fibrinogen and creatinine concentration in blood serum, general bilirubin, prothrombin index (PTI), Ph-plasma, the state of blood clotting system. The state of every sign should be evaluated in points to be then summed up and at exceeding the sum of points being above "+20" one should predict unfavorable result. At the sum of "-13" prediction should be stated upon as favorable and at "-13" up to "+20" - prediction is considered to be doubtful.

EFFECT: higher accuracy of prediction.

2 ex, 3 tbl

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