Objective : to evaluate changes in T- and B-lymphocyte subpopulations at different stages of rheumatoid arthritis (RA). Patients and methods . The study included 53 patients with a definite RA diagnosis according to the 2010 ACR/EULAR criteria (mean age 54.2 [47; 62] years). Group 1 included 27 patients (25 women and 2 men) without history of synthetic disease modifying anti-rheumatic drugs (sDMARDs) intake, group 2 included 26 patients (22 women and 4 men) receiving sDMARDs (methotrexate or leflunomide). The control group consisted of 29 healthy volunteers (23 women and 6 men), the median age was 58.5 [53; 62] years. In all participants flow cytofluorometry according to the standard technique with immunophenotyping of T- and B-lymphocytes was performed. Results and discussion . Compared to controls, patients in group 1 who had not previously received sDMARDs showed a transient increase in "switched" memory B-cells, transient B-cells, and plasmablasts, which was not observed in patients of group 2 (on sDMARDs therapy). Patients with advanced RA showed a statistically significant decrease in the absolute and relative number of memory B-cells, the absolute and relative number of "switched" B-lymphocytes, as well as the number of plasmablasts and transient cells. In RA patients, a statistically significant rela tionship was established between the number of swollen joints and the level of plasmablasts (r=0.51), memory cells (r=0.54), and "switched" B-cells (r=0.41), p< 0,05 in all cases. There were no statistically significant changes in other subpopulations of B-lymphocytes and the profile of T-lymphocytes. Conclusion . Changes in the B-lymphocyte profile are characteristic of different stages of RA. At an early stage, there is an increase in the number of transient B-lymphocytes, plasmablasts and plasmocytes, and in the advanced stage, a decrease in the level of certain populations of B-lymphocytes, such as memory B-cells and "switched" B-lymphocytes. It can be assumed that the ineffectiveness of sDMARDs is associated with a change in the population composition of B-lymphocytes, which requires further study.

IV (XXVII) Национальный конгресс эндокринологов с международным участием «ИННОВАЦИОННЫЕ ТЕХНОЛОГИИ В ЭНДОКРИНОЛОГИИ» 22-25 сентября 2021 года ФЕНОТИПЫ ОЖИРЕНИЯ ПРИ РАННЕМ РЕВМАТОИДНОМ АРТРИТЕ Горбунова Ю .Н ., Кондратьева Л .В ., Попкова Т .В

Proinflammatory cytokines involved in the pathogenesis of rheumatoid arthritis (RA) are able to inhibit the production of insulin and to cause insulin resistance in peripheral tissues. Conceivably RA increases the risk of developing carbohydrate metabolic disturbances (CMDs), such as diabetes mellitus (DM), fasting hyperglycemia (FH), and impaired glucose tolerance. Patients with a concurrence of RA and DM belong to a category of the most critically ill patients with a poor prognosis of macro- and microvascular complications. Objective : to estimate the rate of CMDs (DM and FH) in a cohort of patients with RA and their possible impact on the course of arthritis. Subjects and methods . The investigation enrolled 165 patients (28 men and 137 women) aged 55 [47; 61] years who were diagnosed with RA and followed up at the V.A. Nasonova Research Institute of Rheumatology. The patients who were seropositive for rheumatoid factor and anti-cyclic citrullinated peptide antibodies were 86.3 and 78.8%, respectively. RA activity was low in 29.1% of the patients, moderate in 48.5%, and high in 22.4%. Glucocorticoids (GC) were taken at a mean dose of 5 [5; 7.5] mg/day by 40.6% of the patients; methotrexate, leflunomide, and genetically engineered biological agents were used by 72.7, 8.5, and 23.7%, respectively. A survey was conducted among the patients to find out their awareness of the presence of CMDs and fasting venous plasma glucose levels were determined to screen for hyperglycemia. Height and weight were measured and body mass index (BMI) was calculated. Results. CMDs were present in 21 (12.7%) of the 165 patients with RA. Only 11 (6.7%) of the 165 patients were aware of having DM (2 cases with type 1 DM and 9 with type 2 DM); laboratory tests revealed CMDs in the remaining 10 patients (8 cases with FH and 2 with type 2 DM). The patients with DM and FH had a large number of tender joints (TJN) and high scores of general health survey (GHS) and DAS28 than those with normal blood glycose levels, but did not differ in RA duration, acute-phase indicators (erythrocyte sedimentation rate, C-reactive protein), and the number of swollen joints. Fifty-seven (34.5%) patients were overweight and 39 (23.6%) were obese. In the patients who took GC, glucose levels were lower (5.1 [4.7; 5.5]) than in those who did not (5.4 [5.0; 5.9] mmol/l; p = 0.001) and correlated with BMI ((r = 0.3; p = 0.01). Conclusion. The investigation demonstrated the high rate of DM and FH in RA, but low patient awareness of these conditions, as well as the relationship of CMDs to arthritis activity mainly due to the changes of subjective indices (GHS and TJN). The intake of GC and BMI may affect blood glucose levels in RA.

AIM:To estimate the frequency of obesity in a Russian cohort of patients with early rheumatoid arthritis (RA), determine adipocytokine (adiponectin, leptin) levels and their relation to RA activity.MATERIALS AND METHODS:47 patients with early RA fulfilling ACR/EULAR(2010) criteria and using no BAID or GC. Mean age 57 [47;62] yr, duration of disease 7 [4;8] yr, median of DAS28 5.9 [5.3; 69]. Control group included 30 age-matched healthy donors. The degree of obesity was assessedfrom metabolic syndrome criteria (NCEP/ATPIII, RSSC, WHO); leptin and adiponectin were measured by ELISA, the L/A ratio was calculated.RESULTS:Patients with RA had the same mean BMI but greater waist circumference (WC) and waist/hip ratio than controls (p=0.003 and p = 0.04). Obesity was diagnosed in 63.8 and 40% of the patients in these groups (p=0.04) based on NCEP/ ATPIII criteria and in 65.9 and 40% respectively by WHO criteria. The occurrence of obesity by RSSC criteria was not significantly different (p = 0.9). In patients with RA adiponectin level was higher (p=0.04) while leptin level and L/A ratio lower (p=0.02 and 0.003) than in controls. BMI correlated with ESR, CRB, DAS28, leptin and L/A (p<0.05) in both groups. ESR positively correlated with leptin level andA/L but negatively with adiponectin level (p<0.05).CONCLUSION:The study showed high prevalence ofobesity in patients with early RA and its relation to inflammation. It was associated with increased serum adiponectin level, decreased leptin level and insulin resistance.