EFFECT OF SUBCUTANEOUS METHOTREXATE ON THE STRUCTURE AND FUNCTION OF THE VASCULAR WALL IN PATIENTS WITH RHEUMATOID ARTHRITIS

Abstract

Objective: to evaluate the effect of a subcutaneous methotrexate (MT) formulation (methoject), on the structure and function of the vascular wall in patients with rheumatoid arthritis (RA). Subjects and methods. A total of 94 RA patients who met the 1987 ACR or 2010 ACR/EULAR classification criteria and who were positive for IgM rheumatoid factor (RF) and/or anti-citrullinated peptide antibodies (ACPA) were examined. Carotid arteries were examined to assesslocal vascular wall stiffness, regional arterial stiffness and pulse wave velocity before and 12 months after start of MT therapy. Results and discussion. The patients with RA were found to have subclinical great artery lesion manifesting itself as increases in common carotid artery (CCA) intima-media thickness (IMT) and stiffness index and as rises in peripheral augmentation index (AIp), stiffness index (SI), and reflection index (RI), the values of which correlated with the duration of RA, DAS28, the level of RF, and the concentration of ACPA. The use of MT in the patients with RA caused a statistically significant reduction in DAS28 and a decrease in CCA intima-media complex and local vascular (carotid) stiffness. More significant changes were observed when the duration of RA was less than 2 years; by the end of the follow up, this group showed a 29% decrease in CCA IMT (p < 0.01) and an average of 22.5% reduction in CCA stiffness (p < 0.05). 12-month MT therapy decreased AIp, SI, and RI valuesto a greater extent in the patients who had RA of less than 2 years; in this patient group, these parameters reached the reference values; in late RA, there were their average decreases by 1.7 (p < 0.01), 1.3 (p < 0.01), and 1.8 (p < 0.05) times, respectively. Conclusion. MT therapy has vasoprotective activity, which is characterized by a reduction in the signs of CCA remodeling and regional stiffness in the vascular bed.