Blagodarenko G. Clinical and pathogenetic peculiarities of the rheumatoid arthritis course in the presence of endothelial and subclinical hypothyroid dysfunctions

Objectives - endothelial dysfunction (ED) and subclinical hypothyroid dysfunction (hypoSTD) in patients with rheumathoid arthritis (RA) and their changes after the treatment; the aim - to determine the clinical and pathogenetic details of the RA course in the presence of ED and hypoSTD and to develop new diagnostic and treatment approaches; methods - clinical, biochemical, radiologic, ultrasonic, electrophysiological, immune-enzyme, statistic; novelty and results - the significant occurrence of thyroid affections in patients with RA in Donbas region is established at the first time and it is revealed, that their most common type is hypoSTD, it is determined, that more significant radiologic and functional joint changes, signs of higher activeness of the inflammatory process and the systemic manifestations were more frequent in the RA patients, having hypoSTD, augmentation of titers of antibodies against thyroid peroxidase (aTPO) is revealed in all the RA patients, especially in the presence of hypoSTD, the positive correlation between the aTPO and the phase of the inflammatory process is established. It is shown by both the functional probes' data and the intercellular adhesive molecules' (ICAM-1) rate, that the ED develops in the most RA patients with hypoSTD, the levothyroxinum usage in complex RA patients with hypoSTD treatment is first pathogenetically based, as it makes condition upon reduction of joint syndrome manifestations and of the aTPO rate, upon positive dynamic of inflammation markers and the life quality improvement, it is substantiated, that complex treatment results in lessening of ED intensity and in growth of number of the patients free from ED manifestations, according both endothelial vasculomotor function indices and ICAM-1 rate; it was put into the practice of the rheumatologic departments of Lugansk and Lviv regional clinical hospitals, of Lugansk-City multifield clinical hospital N1, of Donetsk Regional Clinical Territory Medical Assotiation; of the therapeutic clinics of V. K. Gusak Research Institute of Emergensy and Restorative Surgery of the National Academy of Medical Sciences of Ukraine and of M. Gorky Donetsk National Medical University, and also into the pedagogic process of the State institution "Lugansk State Medical University", of Donetsk, Kharkov and Lviv national medical universities; sphere of usage - the process of treatment and diagnostic in rheumatologic and therapeutic departments, the pedagogic process on therapeutic chairs of medical educational institutions.