Galyutina O. Metabolic risk factors in patients with rheumatoid arthritis: associate with a course of disease and character of pharmacotherapy

Objectives - metabolic risk factors with rheumatoid arthritis (RA); aim - basing on study of risk factors (hyperhomocysteinaemia, dyslipidaemia, CRP) of cardiovascular pathology in patients with RA and their connection with clinical course - to develop approaches of detection predictors of affection cardiovascular system in the given patients category; methods used - clinical, radiological, biochemical, immunoenzymatical, instrumental, statistical; newness and results- metabolic risk factors of cardiovascular pathology in patients with RA have been fully studied for the first time with their interrelation with features of underlying disease and the status of cardiovascular system; іt has been determined, that the level of homocysteine in blood is increased in RA patients, which associated with traditional risk factors (a male, age, dyslipidaemia, an arterial hypertension, smoking) and inflammatory process activity factors (CRP, the tumor-necrosis factor-? (TNF-?) and DAS); dyslipidaemia of RA patientsis characterized by increasing blood level of triglycerides and decreasing level of high-density lipoprotein cholesterol. It has been shown, that intensity of dyslipidaemia in RA patients is associated with age, clinical course and inflammatory process activity; it has been shown, that reliable higher levels of cholesterol, low-density lipoprotein cholesterol, triglycerides and lower level of high-density lipoprotein cholesterol are registered in patients with high level of CRP and TNF-?; it has been proved, that RA patients have endothelium dysfunction in form of decreasing endothelium-dependent dilatation of brachial artery and increasing the activity of von Willebrand factor, which is combined with thickening of intima-media complex of carotid artery and increasing the quantity of atherosclerotic plagues; it has been determined, that morphfunctional status of myocardium of RA patients is characterized by increasing the mass of left ventricle and it's remodeling; the enlargement of left ventricle mass has been associated with an arterial hypertension and especially with metabolic syndrome presence; it has been proved for first time that in RA patients there is tight direct correlation between mass of left ventricle of heart and the blood level of homocysteine; it has been shown, that hypertrophy of left ventricle and diastolic dysfunction is observed more frequently among patients with high level of CRP, TNF-?, DAS and HAQ; it has been introduced into practice of therapeutic-preventive departments in Donetsk, Vinnitsa, Khmelnitskiy regions, and also into a teaching process in Donetsk and Vinnitsa Medical Universities; application - medical-diagnostic process at rheumatological, cardiological and therapeutic departments, a teaching process at therapeutic sub-faculties of medical universities.