Прогнозирование тяжести остеопороза у пациентов с ревматоидным артритом путем определения уровня фетуина-А

Abstract

Aim of study. To investigate the level of dependence of osteoporosis (OP) progression severity on the level of fetuin-A (FA) in order to predict the OP progression severity in RA patients. Material and methods. We have examined a total of 110 RA patients (mean age 54.2+11.97). Th e diagnosis was established based on ACR/EULAR criteria 2010. A total of 30 conventionally healthy subjects were enrolled serving as a control group. Evaluation of bone mineral density (BMD) was performed using DXA (Lunar DPX-NT GE densitometer). The FA level was determined through indirect enzyme-linked immunoassay (Human Fetuin-A ELISA test-system). Results. Mean serum FA in healthy subjects amounted to 653.55-972.19μg/ml. We formed 2 groups of RA patients: with blood serum FA levels <653.55μg/ml (23 patients) and with normal FA values: 653.55μg/ml or higher (87 patients). A lowered FA level was revealed in 20 (86.96 %) subjects in the group of OP patients and only in 3 (13.04 %) patients with RA without OP (р<0.001). Osteoporotic bone fractures were diagnosed in 12 (13.79 %) patients in the group with normal FA levels and were absent in 75 (86.21 %) patients (р<0.001). Apart from that, RA patients with lowered FA had reliably lower mean BMD in the area of femoral neck and vertebral column as well as lower BMD total value (р<0.001). In order to determine the diagnostic accuracy of laboratory tests, the characteristic curve (ROC curve) was applied. Th e area under the ROC-curve was 0.663 with the cut-off point matching the FA level of 660.3μg/ml. Th is value corresponds with 84.72 % specifi city and 47.37 % sensitivity. Conclusion. We have revealed reliable correlations between the serum FA level in RA patients, the frequency of OP development, osteoporotic bone fractures and BMD values (p<0.001). Laboratory evaluation of FA for OP progression severity prediction for RA patients has good quality with the specifi city of 84.72 % and the sensitivity of 47.37 %.