Marushko E. Clinical, immunological, morphological and functional characteristics of cardiovascular system state in children with juvenile rheumatoid arthritis and systemic lupus erythematosus.

The thesis is devoted to resolving of actual issue in pediatrics - the improvement of diagnosis of the cardiovascular system involvement in children with juvenile rheumatoid arthritis (JRA) and systemic lupus erythematosus (SLE), based on study of the heart, blood vessels and endothelial function condition. We investigated the cardiovascular system and endothelial function condition at the onset of the disease. Using ultrasound, we performed determination of left ventricular myocardium mass index thickness, common carotid arteries and abdominal aorta intima-media thickness, common carotid arteries wall stiffness index in children with JRA and SLE depending on the duration of the disease. That showed more pronounced and rapidly progressive involvement of heart and blood vessels in patients with systemic JRA and SLE compared to non-systemic JRA. The results of the study showed endothelial dysfunction in patients with JRA and SLE according to the endothelium-dependent dilation of the brachial artery and determining of sICAM-1 serum concentration, which continues to persist even in the absence of disease activity. We revealed changes in the microvasculature of patients with systemic form of JRA and SLE using digital nailbed capillaroscopy. It was proved that prescribing adalimumab and tocilizumab in complex treatment of patients with JRA, which are resistant to standard therapy significantly reduces the disease activity, slows the progression of subclinical heart and blood vessels involvement, normalizes endothelial function. We gave evident that inclusion the omega-3 polyunsaturated fatty acids in comprehensive treatment of children with JRA improves endothelial function and slows the progression of subclinical heart and blood vessels lesion.