The dissertation presents a solution to the current scientific task of rheumatology regarding the optimization of diagnosis and correction of cardiovascular risk in patients with RA.
Based on the results of a complex examination (clinical, laboratory, enzyme-linked immunosorbent, instrumental and statistical methods) the following parameters were determined: the lipid profile of patients with RA considering the activity and duration of the disease; the parameters of platelet indices in patients with RA and their dependence on the activity of the inflammatory process; the morpho-functional state of vessels in patients with different activity and duration of RA; a reliable relationship between von Willebrand factor, intercellular adhesion molecule-1 and changes in the morpho-functional state of the vascular wall; the positive effect of complex therapy with vitamin D and atorvastatin in the management of patients with RA was investigated. This study involved 120 patients with a verified diagnosis of RA, which was established based on the ACR/EULAR criteria of 2010 and the order of the Ministry of Health of Ukraine No. 263 dated 04/11/2014. According to RA activity indicators according to DAS28, patients were divided into 3 subgroups, 40 people in each. Each subgroup of patients was divided into two parts of 20 people each, taking into account RA activity. One part was prescribed basic therapy by the Order of the Ministry of Health of Ukraine No. 263 of April 11, 2014. The other 20 patients received, in addition to the basic therapy, Vitamin D (4000 MO/day) and atorvastatin (40 mg/day) for 12 consecutive weeks.
For the first time, the relationships of a complex of such platelet indices (TI) as mean platelet volume (MPV), platelet distribution width (PDW), thrombocytocrit (PCT), and platelet-to-lymphocyte ratio (PLR) with RA activity and with a cardiovascular risk index were established. It was investigated that MPV and PDW were lower among RA patients than healthy subjects. The lowest values of MPV and PDW were found among patients with high RA activity (9,37±0,05 and 18,33±0,06 p<0,05, respectively).
For the first time, the dynamics of IL-8, vWF, and ICAM-1 indices among patients with RA before and after the appointment of basic and complex therapy were studied. According to the results of this work, these parameters were characterized by an improvement during the basic therapeutic intervention (IL-8 to 231,8 (197,6 – 280,8) after 86,8 (71,5 – 148,9), p<0,001; vWF to 44,9 (21,5 – 58,1) after 37.6 (20,7 – 44,8), p<0,005; ICAM-1 to 366,4 (310,74 – 34,5) after 257,8 (124,3 – 294,8), p<0,005). However, the complex treatment showed significantly better results when compared with basic therapy (IL-8 81,8 (70,9 – 140,8), p<0,05; vWF 32,8 (21,4 – 45,5), p<0,05; ICAM-1 225,7 (105,3 – 259,6), p<0,05).
The study determined the association of von Willebrand factor and intercellular adhesion molecule-1 with disease activity, inflammation indicators and morphometric parameters of the intima-media thickness (IMT) among patients with RA. Their role as potential predictors of IMТ thickening of carotid arteries in individuals with RA was studied. It has been proven that complex therapy with the use of vitamin D and atorvastatin showed better treatment results. The proportion of non-responders in the group of basic therapy was 17 %, while with complex therapy it was half as low (8 %). The most pronounced therapeutic effect according to ACR 70 was observed in 3 people (5 %) who received basic therapy and in 5 patients (8 %) during complex treatment. The effectiveness of ACR 50 treatment was observed in 25 % of patients after basic treatment and in 40 % of people who were prescribed complex therapy.
Key words: rheumatoid arthritis, cardiovascular risk, diagnosis, treatment, vitamin D, atorvastatin, lipoproteins, platelet indices, intercellular adhesion molecule-1, von Willebrand factor, ELISA. Branch - medicine.
