Abstract
The article presents the results of evaluation of leflunomide impact on endothelial function and vascular stiffness parameters in patients with rheumatoid arthritis (RA), but without cardiovascular diseases. 46 patients with RA satisfying ACR (1987) or ACR/EULAR (2010) classification criteria were examined. Investigations of endothelial function and arterial stiffness, based on the pulse wave contour analysis and the reactive hyperemia test (“AngioScan-01” device used), were conducted before the treatment and 12 months thereafter. It was determined that patients with RA suffered from subclinical damage of large arteries, characterized by endothelial dysfunction at micro- and macrocirculatory levels, and the increase in augmentation (AIp), stiffness (SI), and reflection (RI) indices, whose value correlated with RA duration, DAS28 activity index, RF level, and ACCP concentration. Leflunomide use in patients with RA was accompanied by statistically significant decrease in DAS28 index. It was shown that along with high anti-inflammatory activity leflunomide is also able of decreasing the signs of subclinical arterial damage, which is confirmed by the restoration of the endothelial function both in the system of small resistant vessels (increase in amplitude occlusion index) and large muscular arteries (increase in the value of phase shift between channels), and the decrease in stiffness of large arteries.
Highlights
CHANGES IN ENDOTHELIAL FUNCTION AND ARTERIAL STIFFNESS PARAMETERS IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH LEFLUNOMIDE Knyazeva L.A., Knyazeva L.I., Meshcherina N.S., Goryainov I.I., Ponkratov V.I
The article presents the results of evaluation of leflunomide impact on endothelial function and vascular stiffness parameters in patients with rheumatoid arthritis (RA), but without cardiovascular diseases. 46 patients with RA satisfying ACR (1987) or ACR/EULAR (2010) classification criteria were examined
It was determined that patients with RA suffered from subclinical damage of large arteries, characterized by endothelial dysfunction at micro- and macrocirculatory levels, and the increase in augmentation (AIp), stiffness (SI), and reflection (RI) indices, whose value correlated with RA duration, DAS28 activity index, RF level, and ACCP concentration
Summary
В исследовании приняли участие 46 пациентов с РА, соответствующих классификационным критериям ACR (1987) и/или ACR/EULAR (2010), с длительностью заболевания от 6 месяцев до 5 лет. Критерии включения: информированное согласие пациента, активное течение РА в течение последних 3 месяцев; неэффективность предшествующей терапии метотрексатом или наличие противопоказаний к его назначению; сохраненная способность к самообслуживанию; отсутствие противопоказаний к применению лефлуномида. Активность заболевания по DAS28 была умеренной у 6 пациентов и высокой у 40 больных. Внесуставные проявления заболевания были определены у 29 (63%) больных, среди которых наиболее часто встречались ревматоидные узелки (n = 9) и амиотрофический синдром (n = 18), также наблюдались анемия (n = 4), нейропатия (n = 2) и капиллярит (n = 1). Включенных в исследование, у 7 (15%) больных имел место отягощенный по ССЗ семейный анамнез, при оценке по шкале SCORE определен умеренный (n = 28) или низкий (n = 18) кардиоваскулярный риск
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