The purpose of the study was to determine the contribution of RANKL/OPG transmembrane molecule system into the development of pathological arterial stiffness in rheumatoid arthritis (RA). RA patients (n=181) were randomized into 4 groups based on RF/ACCP (rheumatoid factor/antibodies to cyclic citrullinated peptide) positivity and disease duration (less than or more than 2 years). Serum osteoprotegerin (OPG) and soluble receptor activator of NF-kB ligand (sRANKL) concentrations, as well as pulse wave contour analysis were evaluated in all patients. The largest OPG level was detected in Group 1 patients; sRANKL concentration with maximal RANKL/OPG ratio was predominant in Group 4 patients. Prolonged course of RF/ACCP-seropositive RA was characterized by more significant arterial rigidity shifts (increases in augmentation (AIp), stiffness (SI), reflection (RI) indices). Correlation analysis revealed the presence of significant relations between the RANKL/OPG transmembrane molecule system and arterial rigidity parameters in RA.

There were analyzed 86 minutes of duplex scanning of the common carotid arteries and pulse wave contour analysis performed in patients with rheumatoid arthritis (RA) not accompanied with cardiovascular disease at the age of 18 to 50 years, with case history of less than two years. There were found the signs of remodeling of the common carotid arteries (increased intima-media thickness and в stiffness index) and increase of regional stiffness of vascular wall (increased augmentation index (AIp75), stiffness (SI) and reflection (RI)) already at the early stages of the disease, more expressed in the RF / anti-CCP-positive RA variant. Correlation analysis confirmed the contribution of the disease-related factors (activity of chronic immunological process seropositivity for IgM RF and anti-CCP) to change of the architectonics of the vascular wall, progression of arterial stiffness, both at the local and regional levels.

The study of the relationship of proinflammatory mediators (hs-CRP, TNF-α, IL-6 and IL-1β) with indicators of endothelial function at the micro level and makrotsirkulyatornom vascular bed in RA patients without concomitant cardiovascular disease. Take into account the clinical and immunological variant and disease duration. The results suggest that overproduction of TNF-α and IL-1β in the early stages of RA induces endothelial dysfunction mainly on the microcirculatory level, while the excessive synthesis of IL-6 and hs-CRP as the disease progresses potentiates the development of macrovascular endothelial dysfunction, more degree at RF / CCPA-seropositive subtype.

FIELD: medicine. SUBSTANCE: leflunomide in a dose of 100 mg a day for the first 3 days, 20 mg once a day continuously is prescribed orally as a standard baseline anti-inflammatory therapy in a patient with the active clinical course of the disease if the previous therapy with methotrexate appeared ineffective or the patient shows counter-indications for the use thereof. EFFECT: method provides the effective correction of the structural-functional arterial bed disorders in the patients of the above category by the fact that leflunomide combined the immunomodulatory and anti-inflammatory effects and vasoprotective action on the walls of greater vessels of elastic type and small arteries of muscular type. 1 ex, 1 tbl

The article presents the results of researching the arterial wall endothelial function and stiffness parameters in 44 patients with various duration of IgM RF-seropositive rheumatoid arthritis (RA). The research of the endothelial function and arterial stiffness included the pulse wave contour analysis and reactive hyperemia test carried out with the use of “Angioscan-01” device (“Angioscan-Electronics” LLC, Russia). The pulse wave contour analysis in patients with RA determined the presence of “A”and “B”-type curves; augmentation (Alp), reflection (RI) and stiffness (SI) indices were significantly higher in patients with RA compared to the controls, more prominent changes of the researched parameters were determined in patients with the disease duration exceeding 2 years. When analyzing the parameters of reactive hyperemia test in patients with RA, a significant decrease in the occlusion index and the value of phase shift between channels was determined; such changes advanced along with the increase in the disease duration. Direct correlation relationships were determined between Аpl and SI indices and RA duration; inverse correlation relationships were determined between the occlusion index by amplitude and Apl, SI, RI indices in patients with the RA duration exceeding 2 years.

The article introduces the investigation results of the proinflammatory cytokine concentration (Il-1β, Il-6, TNF-α), TNF-R1 in the blood of 54 patients with rheumatoid arthritis. The research has revealed the differences between the levels of the analyzed cytokines in the patients with different duration of rheumatoid arthritis (RA) that has shown the considerable increase in the concentration of TNFα, TNF-R1, IL-1β, at the extensive stage of the disease. The patients with the tardy RA revealed the highest possible concentration of IL-6 in the blood serum. Rituximab therapy was associated with the corrective influence on the cytokine status in the blood serum in the patients with the extensive stage of RA.

Проведена оценка показателей цитокинового статуса в синовиальной жидкости и качества жизни у 64 больных ревматоидным артритом (РА). Установлены отличия в содержании ИЛ-1β, ИЛ-6, ИЛ-8, ФНО-α и васкулоэндотелиального фактора роста-А (ВЭФР-А) в синовиальной жидкости больных в зависимости от позитивности по ревматоидному фактору (РФ). У серопозитивных по РФ пациентов преобладало содержание ИЛ-1β и ВЭФР-А, при серонегативном РА – ФНО-α, ИЛ-6, ИЛ-8. Определена большая эффективность влияния ритуксимаба на показатели цитокинового статуса и качество жизни у больных с серопозитивным по РФ вариантом РА.

В настоящей статье представлены результаты исследования содержания цитокинов провоспалительного действия (ИЛ-1β, ИЛ-6, ФНО-α), остеопротегерина (OPG), рецептора активации ядерного фактора Карра (RANKL), васкулоэндотелиального фактора роста-А (ВЭФР-А) в синовиальной жидкости у 74 больных ревматоидным артритом (РА). Установлены различия в уровне исследованных цитокинов у больных с различной длительностью заболевания. Определена большая эффективность корригирующего действия ремикейда в сравнении с метотрексатом на показатели цитокинового статуса, большая результативность терапии достигнута при раннем РА.

In this article is observed the results of investigations of cytokins status in synovial liquid of the 76 patients with psoriatic arthritis, treated with metotrexate (MT) in comparison with MT + infliximab (INF) treatment. So, it is found that the influence of INF + MT concentration of moderate proinflammatory cytokins in sinovial liquid of psoriatic arthritis patients is much more effective in comparison with MT therapy.

The results of the research of cytokines status in the synovial liquid of the 64 rheumatoid arthritis (RA) patients are offered in this article. The differences between the concentrations of interleikin-1β (IL-1β), interleikin-6 (IL-6), interleikin-8 (IL-8), tumor necrosis factor-α (TNF-α) and vasculoendothelial growth factor-A (VEGF-A) were estimated in the synovial liquid of RA patients, according to the serological subtypes (rheumatoid factor-RF). In seropositive patients the higher concentration of IL-1β and VEGF-A took place and the seronegative variant of RA was characterized by the increased levels of TNF-α, IL-6, IL-8. The efficacy of rituximab therapy was more distinguished in the patients with seropositive RA.