AB0258 STATE OF ADIPOCYTOKINES IN PATIENTS WITH RHEUMATOID ARTHRITIS

Abstract

BackgroundАdipose tissue is actively involved in the development of systemic inflammation in rheumatoid arthritis (RA), producing proinflammatory cytokines and adipocytokines that can independently modulate inflammatory and destructive processes in the joints [1-2].ObjectivesTo establish the relationship between serum adiponectin and leptin in patients with RA with clinical and laboratory indicators of disease activity and the results of ultrasound examination (US) of the hand joints.MethodsThe study included 72 women with RA according to the ACR / EULAR criteria of 2010 who visited the adaptation therapy clinic of Orenburg State Medical University. The mean±SD age was 46.4±7.5 years and the mean±SD disease duration was 7.9±4.4 years.Clinical study of patients with RA included an assessment of the tender joint count (TJC) (11.3±6.8), the swollen joint count (SJC) (4.6±2.7), duration of morning stiffness (107.5±49.3 min) and the patient’s global assessment according to a 100-millimeter visual analogue scale (46.2±23.5 mm). Disease activity was assessed by the DAS28 index (4.4±1.7).The mean body mass index (BMI) in patients with RA was 26.3 ± 6.2 kg/m2.We evaluated for the following laboratory tests: rheumatoid factor (RF), antibodies to cyclic citrullinated peptide (A-CCP), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-17 (IL-17), adiponectin and leptin in blood serum.We carried out US to determine the inflammatory and destructive changes in 30 joints in each RA patient (wrist joints, metacarpophalangeal, proximal and distal interphalangeal joints and the first interphalangeal joint on the palmar and dorsal sides of both hands) by the device “Philips Epiq 7” with linear transducer with a frequency of 5-18 MHz and the use of Power Doppler (PD) which included the identification of synovitis, tenosynovitis, erosive changes in the hand joints.At the time of examination, 30 (41.7%) patients with RA received therapy that included methotrexate (МТХ); 9 patients (12.5%) intook glucocorticosteroids (GCS) perorally, MTХ+GCS – 15 patients (20.8%).The program STATISTICA, 12.0 was used for statistical analysis.ResultsThe level of serum adiponectin negatively correlated with the level of CRP (r=-0.3, p <0.05). At the same time, significant correlations were found between the number of erosions of the joint space and the level of adiponectin (r=0.5, p <0.0001). Also, additional correlations were noted between adiponectin levels and the intake duration of MTX (r=0.3, p <0.05) and GCS (r=0.4, p <0.001).We found a positive correlation between the level of leptin and BMI (r=0.5, p <0.0001). In addition, there were significant correlations between the level of serum leptin and the morning joint stiffness duration (r=0.4, p <0.0001), TJC (r=0.5, p <0.0001), as well as the level of CRP (r=0.4, p <0.001) and the DAS 28 index (r=0.4, p <0.001) in patients with RA. An increase in IL-17 concentration was associated with an increase in leptin levels (r=0.3, p <0.05) in RA patients. However, we did not find a significant correlations between serum adipokine concentrations and RF and A-CCP levels.ConclusionLevel of adiponectin is associated with pronounced destructive changes in the joints and the intake duration of MTX and GCS. There is a positive relationship between the level of leptin and indicators of disease activity (TJC, level of CRP, DAS28-CRP index) and an increased blood flow during Doppler imaging, which indicates its role as a proinflammatory cytokine.