scholarly journals Level of N-terminal fragment of brain natriuretic peptide progenitor and atherosclerotic damage of brachocephalic arteries in patients with rheumatoid arthritis with inefficiency and/or injurability of basic anti - inflammatory treatment

2019 ◽  
Vol 91 (5) ◽  
pp. 34-39
Author(s):  
E V Gerasimova ◽  
T V Popkova ◽  
A V Martynova ◽  
E I Markelova ◽  
D S Novikova ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cardiovascular Diseases ◽  
Natriuretic Peptide ◽  
Prognostic Significance ◽  
Atherosclerotic Lesion ◽  
Control Group ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Traditional Risk Factors

The high prognostic significance of the concentration of the N-terminal - pro-B-type natriuretic peptide (NT-proBNP) in the development of cardiovascular diseases (CVD) was identified for rheumatoid arthritis (RA) and general populations. Aim: to investigate the significance of NT-proBNP level in patients (pts) with RA with the ineffectiveness and/or intolerance of basic anti - inflammatory therapy; compare the level of NT-proBNP with atherosclerotic lesion of the brachiocephalic arteries (BCA), traditional risk factors and inflammatory markers. Materials and methods. The investigation enrolled 28 pts (24women/4men) with the lack of efficacy/resistance and/or intolerance of basic anti - inflammatory drugs (DMARDs); median age was 55 [46; 61] years, median disease duration 114 [60; 168] month; DAS28 6,2 [5.1; 7.0]; SDAI 35.0[23.9; 51.0], CDAI 30.0[21.0; 42.0], serum positivity for rheumatoid factor (RF) (100%)/anti - cyclic citrullinated peptide antibodies (ACCP) (86%). The study did not include RA pts with congestive heart failure. High incidence of traditional risk factors was found in RA pts: arterial hypertension - in 75%, dyslipidemia - 61%, smoking - 17%, overweight - 61%, family history of cardiovascular diseases - 36%, hypodynamia - 68%. Coronary artery disease was diagnosed in 11% RA pts. Lack of efficacy of 3 or more DMARDs was found in 46% of pts, intolerance to previous therapy with DMARDs - in 54% pts. 47% were receiving methotrexate (20 [18; 25] mg/week), 11% - leflunomide, 7% - sulfasalazine, 46% - glucocorticoids, 75% - non - steroidal anti - inflammatory drugs. The control group consisted of 20 healthy donors, comparable to pts by age and sex. Serum levels of of NT-proBNP were measured using electrochemiluminescence method Elecsys proBNP II (Roche Diagnostics, Switzerland). The determination of the intima - media thickness (IMT) BCA were assessed from duplex scanning. Atherosclerotic lesion of BCA was assessed by the presence of atherosclerotic plaque (IMT ≥1.2 mm). Results. NT-proBNP concentrations in RA pts proved to be higher (78.7 [41.4; 101.3] pg/ml) than those in the control group (55.3 [36.6; 67.3] pg/ml, p100 pg/ml - 1 group (n=6) and ≤100 pg/ml - 2 group (n=22). Groups of RA pts did not differ in gender, age, activity of RA, frequency of detection of traditional risk factors. Atherosclerotic lesion of the BCA was detected in 3 (50%) pts of the 1 group and in 8 (36%) pts of the 2 group (p>0.05). In RA pts the level of NT-proBNP correlated with age (r=0.39; p

scholarly journals FRI0063 LEVEL OF N-TERMINAL FRAGMENT OF BRAIN NATRIURETIC PEPTIDE PROGENITOR AND ATHEROSCLEROTIC DAMAGE OF BRACHIOCEPHALIC ARTERIES IN PATIENTS WITH EARLY AND LONG-STANDING ACTIVE RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 608.2-608
Author(s):  
H. Gerasimova ◽  
T. Popkova ◽  
M. Cherkasova ◽  
E. Markelova ◽  
S. Glukhova ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Natriuretic Peptide ◽  
Disease Duration ◽  
Atherosclerotic Lesion ◽  
Control Group ◽  
Early Ra ◽  
Terminal Fragment ◽  
Traditional Risk Factors ◽  
Brachiocephalic Arteries

Background:The high prognostic significance of the N-terminal fragment of the B-type natriuretic peptide (NT-proBNP) concentration in the development of cardiovascular diseases (CVD) was identified for rheumatoid arthritis (RA) patients (pts) and general population.Objectives:To investigate the significance of NT-proBNP levels in pts with early untreated and long-standing RA with high disease activity; to identify potential relationship of NT-pro-BNP levels with atherosclerotic lesion of the brachiocephalic arteries (BCA), traditional risk factors and inflammatory markers.Methods:A total of 227 RA pts (76%females, 24%males, 55 [46;61]years old, moderate to high activity (DAS28-5,3[4,6;6,3], SDAI–27(22;35), positive for ACCP (73%)/RF (87%),) were enrolled in the study: 136 pts with early RA (disease duration ≤12 months) and 91 pts with long-standing RA (>12 months). All early RA pts were not treated with glucocorticoids and disease-modifying antirheumatic drugs (DMARDs). Long-standing RA pts already developed the lack of efficacy/resistance and/or intolerance of DMARDs. Lack of efficacy of 3 or more DMARDs was established in 46% of pts, intolerance to previous DMARDs therapy - in 54% pts. 73% were receiving methotrexate, 21% - leflunomide, 7% - sulfasalazine, 46% glucocorticoids. Pts with early and long-standing RA were comparable in terms of age, sex, body mass index and RA activity rates (DAS28, SDAI, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels). High incidence of traditional risk factors was found in early and long-standing RA pts: the incidence rate of arterial hypertension (58%vs68%), overweight (58%vs61%), smoking (27%vs17%), DM type 2 (4%vs7%) were not significantly different. Pts with congestive heart failure were not include in the study. The control group consisted of 20 healthy donors, matched to pts by age and sex. Serum levels of NT-proBNP (pg/mL) were measured using electrochemiluminescence test Elecsys proBNP II (Roche Diagnostics, Switzerland). NT-proBNP levels > 125,0 pg/mL were considered as elevated. The BCA intima-media thickness (IMT) was assessed by duplex ultrasound scanning. Atherosclerotic lesion of BCA was documented in the presence of plaque (IMT≥1,2mm).Results:The NT-proBNP levels were significantly higher in RA pts than in the control group (median 92,1 (48,2-164,7) pg/mL vs 55,3 (36,6-67,3) pg/mL,p<0.05). Pts with early RA had higher NT-proBNP levels (118,9 (60,2-201,3) pg/ml) than pts with long-standing RA (73,4 (43,0-114,3) pg/ml,p<0,001). Elevated NT-proBNP concentrations were found in 71 (52%) early RA pts vs 21 (23%) pts with long- standing RA (р<0,01). Atherosclerotic lesion of the BCA was detected in 73 (54%) pts with early RA and in 37 (41%) pts with long- standing RA (p>0,05). The NT-proBNP levels correlated with age (r=0,51,p<0,001), CRP (0,23,p=0,001) and IMT of BCA (r=0,46,p=0,03) in RA pts. Aforementioned correlations were significantly remained for both groups of RA pts. Association between IMT of BCA and CRP concentrations was not found.Conclusion:NT-pro-BNP levels are higher in pts with active RA than in control subjects. Early untreated RA pts had a higher NT-proBNP levels than pts with disease duration >12 months and resistance or intolerance of DMARDs. The increased concentration NT-pro-BNP (>125pg/ml) were found in half of pts with early untreated RA and every fourth pts with long-standing active RA. NT-proBNP concentration correlated with CRP level in pts with active RA. Correlation between NT-pro-BNP concentrations and IMT of BCA may be indicative of possible impact of this biomarker on atherosclerotic damage of BCA in pts with early and long-standing active RA.Disclosure of Interests:None declared

scholarly journals Rheumatoid arthritis: influence of inflammation and anti-inflammatory therapy on cardiovascular risk factors

2020 ◽  
pp. 32-44
Author(s):  
D. I. Trukhan ◽  
D. S. Ivanova ◽  
K. D. Belus
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Diseases ◽  
Cardiovascular Risk Factors ◽  
Chronic Inflammation ◽  
Pharmacological Intervention ◽  
Increased Risk ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Rheumatoid arthritis is a frequent and one of the most severe immuno-inflammatory diseases in humans, which determines the great medical and socio-economic importance of this pathology. One of the priority problems of modern cardiac rheumatology is an increased risk of cardiovascular complications in rheumatoid arthritis. In patients with rheumatoid arthritis, traditional cardiovascular risk factors for cardiovascular diseases (metabolic syndrome, obesity, dyslipidemia, arterial hypertension, insulin resistance, diabetes mellitus, smoking and hypodynamia) and a genetic predisposition are expressed. Their specific features also have a certain effect: the “lipid paradox” and the “obesity paradox”. However, chronic inflammation as a key factor in the development of progression of atherosclerosis and endothelial dysfunction plays a leading role in morbidity and mortality from cardiovascular diseases in rheumatoid arthritis. This review discusses the effect of chronic inflammation and its mediators on traditional cardiovascular risk factors and its independent significance in the development of CVD. Drug therapy (non-steroidal anti-inflammatory drugs, glucocorticosteroids, basic anti-inflammatory drugs, genetically engineered biological drugs) of the underlying disease also has a definite effect on cardiovascular risk factors in patients with rheumatoid arthritis. A review of studies on this problem suggests a positive effect of pharmacological intervention in rheumatoid arthritis on cardiovascular risk factors, their reduction to a level comparable to the populations of patients not suffering from rheumatoid arthritis. The interaction of rheumatologists, cardiologists and first-contact doctors (therapist and general practitioner) in studying the mechanisms of the development of atherosclerosis in patients with rheumatoid arthritis will allow in real clinical practice to develop adequate methods for the timely diagnosis and prevention of cardiovascular diseases in patients with rheumatoid arthritis.

scholarly journals TRADITIONAL RISK FACTORS FOR CARDIOVASCULAR DISEASES IN SYSTEMIC SCLEROSIS AND THEIR RELATIONSHIP TO STRUCTURAL CHANGES OF THE HEART

2017 ◽  
Vol 54 (6) ◽  
pp. 687-692
Author(s):  
E. O. Saad ◽  
L. P. Ananyeva ◽  
D. S. Novikova ◽  
R. T. Alekperov
Keyword(s):  
Risk Factors ◽  
Systemic Sclerosis ◽  
Cardiovascular Diseases ◽  
Structural Changes ◽  
Clinical Manifestations ◽  
Substantial Contribution ◽  
Control Group ◽  
Russian Society ◽  
Cvd Risk ◽  
Traditional Risk Factors

Objective: to determine the frequency of traditional risk factors (TRFs) for cardiovascular diseases (CVD) in patients with systemic sclerosis (SS) and to analyze their relationship to the clinical manifestations of SS, as well as to structural changes, as evidenced by echocardiography (EchoCG).Subjects and methods. The investigation enrolled 125 patients with SS and 50 sex- and age-matched, apparently healthy individuals included in a control group. Standard electrocardiography was performed in all and EchoCG – in 121 patients. The Systematic Coronary Risk Evaluation (SCORE) scale was used to assess the risk of fatal CVD in 100 patients with SS and in 47 control individuals within 10 years.Results and discussion. The frequency of TFRs in patients with SS was not significantly different from that in the control group, except for the occurrence of hypercholesterolemia and increased body mass index (BMI). In SS, BMI >25 kg/m2 was observed significantly more often and the frequency of hypercholesterolemia was lower than in the controls (p <0.018). Hypertension and diabetes mellitus were slightly more frequently encountered in SS patients than in the controls, but this difference was insignificant. Taking into account the Russian Society of Cardiology (RSC) guidelines, the cardiovascular risk (CVR) was assessed with the SCORE scale. A very high CVR was much more common in SS and a moderate CVR was much more frequently seen in the control group. There were no substantial differences in the frequency of low and high CVRs. SS is characterized by the increased frequency of high total CVD risk as compared to the controls. Hypertension, overweight, and over 50 years of age were associated with more obvious structural heart disease.Conclusion. TRFs make a substantial contribution to the formation of a high CVR in patients with SS, promoting the development of atherosclerosis and its complications. Assessment of TGFs in SS patients will facilitate identifying patients at high risk for cardiovascular death and timely prescribing therapy. Hypertension is an important TGF that in SS is associated with considerable structural changes in the heart; therefore adequate blood pressure control is of importance in improving SS prognosis especially in patients older than 50 years.

Gastrointestinal Risk Factors and Non-steroidal Anti-inflammatory Drugs Use in Rheumatoid Arthritis and Osteoarthritis Patients in Korea

2016 ◽  
Vol 23 (1) ◽  
pp. 47 ◽  
Author(s):  
Eun Young Lee ◽  
Seung-Jae Hong ◽  
Yong-Beom Park ◽  
Kyung-Su Park ◽  
Chan-Bum Choi ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Gastrointestinal Risk ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Effect of Dietary Education on Cardiovascular risk Factors in Rheumatoid Arthritis Patients

2020 ◽  
Vol 16 ◽  
Author(s):  
Rahil Taheri ◽  
Shahram Molavynejad ◽  
Parvin Abedi ◽  
Elham Rajaei ◽  
Mohammad Hosein Haghighizadeh
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Statistical Tests ◽  
Intervention Group ◽  
Serum Levels ◽  
Control Group ◽  
Dietary Education

Aim: The aim of this study was to investigate the effect of dietary education on cardiovascular risk factors in patients with rheumatoid arthritis. Method: In this randomized clinical trial, 112 patients with rheumatoid arthritis were randomly assigned into two groups, intervention and control. Dietary education was provided for the intervention group in 4 sessions; anthropometric measurements, serum levels of RF, triglycerides, cholesterol, HDL, LDL, and fasting blood sugar were measured before and three months after intervention. Data was analyzed using SPSS software and appropriate statistical tests. Results: The mean of total cholesterol (p <0.001), triglycerides (p = 0.004), LDL (p <0.001), systolic blood pressure (p = 0.001), diastolic blood pressure (p = 0.003), FBS and BMI (p <0.001) were decreased significantly in the intervention group after education compared the control group. Conclusion: Traditional care for rheumatoid arthritis patients is not enough. Patients need more education in order to improve their situation.

scholarly journals FRI0094 SIGNIFICANT IMPROVEMENT OF NT-PROBNP LEVELS IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH TOCILIZUMAB AND TOFACITINIB

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 625.2-626
Author(s):  
H. Gerasimova ◽  
T. Popkova ◽  
I. Kirillova ◽  
M. Cherkasova ◽  
A. Martynova ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Cardiovascular Death ◽  
Control Group ◽  
Activity Levels ◽  
Das 28 ◽  
Interleukin 6 Receptor ◽  
Inflammatory Drugs ◽  
Roche Diagnostics

Background:N-terminal pro-brain natriuretic peptide (NT-proBNP) is a recognized predictor of congestive heart failure (CHF) and cardiovascular death. Rheumatoid arthritis (RA) patients (pts) were shown to have higher NT-proBNP concentrations than in general population, but it remains unclear, whether NT-proBNP levels are related to RA duration, activity or treatment.Objectives:To investigate the effect of interleukin 6 receptor inhibitor - tocilizumab (TCZ) and JAK inhibitor - tofacitinib (TOFA) on NT-proBNP levels in RA pts during a 12-month (m) follow-up period.Methods:The study enrolled 60pts (50women/10men) with the lack of efficacy/resistance and/or intolerance of basic anti-inflammatory drugs (DMARDs); median age was 55[42;61] years, median disease duration 55[29;120]m, with moderate to high activity (DAS28-5,1[4,6;6,1], serum positivity for rheumatoid factor (RF)(85%)/ anti-cyclic citrullinated peptide antibodies (ACCP)(80%). The study did not include RA pts with CHF and clinically overt cardiovascular disease (CVD). Twenty nine RA pts received TCZ(8mg/kg) every 4 weeks: 61% received TCZ in combination with methotrexate (MTX), 35% - with low-dose glucocorticoids (GCs). Thirty one RA pts were prescribed oral TOFA at 5 mg BID with dose escalation to 10 mg BID in 8 (26%)pts. TOFA was used in combination with MTX in 90% pts, with GCs – in 29% pts. Pts treated with TCZ and TOFA were comparable in terms of age, sex, body mass index. RA activity rates (DAS28, SDAI, ESR, CRP) were higher in pts on TCZ -therapy compared with pts treated with TOFA. Echocardiography data and NT-proBNP levels using electrochemiluminescence method Elecsys proBNP II (Roche Diagnostics, Switzerland) were obtained at baseline and after 12m.Results:Significant positive changes in major disease activity, clinical and laboratory parameters were found in RA pts after 12 m of TCZ infusion and TOFA intake: remission (DAS28<2,6) was achieved in 54% and 39% pts, low activity levels (DAS28<3,2) – in 46% and 51% pts, respectively.The NT-proBNP levels were significantly higher in RA pts than in the control group (median 69,1 (37,9;105,8) pg/mL vs 55,3 (36,6;67,3) pg/mL,p<0.05).Six pts (10%) (three in each pts group) had NT-proBNP levels over 125pg/ml, but were asymptomatic and had unremarkable echocardiography.There was a good correlation between NT-proBNP level at baseline with age (r=0,55,p<0,001), SDAI (r=0,5, h=0,01), ACCP (r=0,23,p=0,01).Decrease of median NT-proBNP levels was documented after 12m of TCZ therapy (81,5[43,0;102,0]vs41,6[25,4;64,2]pg/ml (p<0,01) and after 12m TOFA therapy (66,1[30,5;105,0]vs16,8 [5,0;81,0]pg/ml,p=0,001).After 12m of TCZ correlations of ΔNT-proBNP were established with ΔESR (R=0,43;p<0,05], ΔСRP (R=0,46;p<0,05], ΔEe left ventricle (LV) (r=0,88,p=0,03).In the group of pts treated with TOFA ΔNT-proBNP level significantly correlated with the percentage change in DAS 28 (r=0,41,p=0,038), there was no direct correlation with changes in the parameters of the LV diastolic function.Conclusion:TCZ and TOFA treatment for 12 m reduced NT-proBNP levels in RA pts without clinically manifest CVD and CHF. Falling NT-proBNP concentrations are associated with positive dynamics of RA activity (DAS 28) and inflammatory markers (CRP, ESR), therefore allowing to suggest that increased NT-proBNP levels should be considered as a component of disease activity. Correlation between ΔNT-proBNP and ΔEeLF may be indicative as possible impact of these biomarkers on the LV diastolic function’s development in RA pts.Disclosure of Interests:None declared

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