The dissertation is aimed at solving a topical issue in PMD optimization of CVD prevention in patients with PsA by developing an algorithm for assessing traditional and additional cardiovascular risk factors to improve early diagnosis of atherosclerotic lesions in patients of this group in PMD. Our study involved 80 patients with psoriatic arthritis and 20 visual impairments. Among them, 60 patients with PsA, aged 18 to 44 years, with a mean age of 39.62 ± 5.8 years (28 (46.66%) women and 32 (53.33%) men), and compared according to demographic indicators, a group of 20 patients with PS (comparison group) 32.3 ± 5.63 years (8 (40%) women and 12 (60%) men), respectively. The control group included 11 women (55%) and 9 men (45%), mean age 32.3 ± 5.63, respectively. The duration of PsA ranged from 3 to 20 years. A retrospective analysis of medical records of patients with PsA with determination of the average level of CRP.
It was found that in patients with PsA the severity of atherosclerotic lesions was more noticeable compared with patients with PS and the control group (RА profiles were the same).In patients with the PSA group, the levels of CRP, ТG, IL-10, IL-17, SC, TIMС and the incidence of AB were significantly higher than in patients with PS and in the control group, which may indicate a pathogenetic link between additional FR and the development of atherosclerotic process. .
The scientific novelty of the work is to solve the current scientific problem of primary care to optimize the prevention of cardiovascular complications and improve the prognosis of cardiovascular complications (diseases) in patients with PsA by studying Doppler features of the main and peripheral arteries with surrogate markers of atherosclerosis.For the first time in Ukraine, the author conducted a study of the profile of traditional and additional CVD in patients with PsA, identified the relationship of traditional RА with the course of the immuno-inflammatory process and their role in atherogenesis in this group of patients.
There are 9 most significant FR.For the first time, recommendations have been developed for referral of patients with early PsA to family ultrasound as part of PMD by a family physician.
For the first time, the role and influence of IL-10 and IL-17 on the condition of the vascular wall and their relationship with other FR CVD in patients with PsA were determined.For the first time in Ukraine, an algorithm for scoring the probability of developing asymptomatic atherosclerotic carotid arteries in patients with PsA was developed and substantiated using mathematical forecasting methods) (Patent of Ukraine № 140327 IPC (2020.01) A61B8 / 00). Based on it, an algorithm for clarifying the cardiovascular risk in patients with PsA, based on traditional FR (tobacco, lipid metabolism) and additional FR (CRP, SC, DAS28) regardless of age and sex, which allows to identify groups of patients with high cardiovascular risk for further use of prophylactic programs and is indicated for patients with PsA without confirmed CVD and a risk of <5% on the SCORE scale.When managing patients with PsA in PMD, it is recommended to determine TcH, TG, HDL cholesterol, LDL cholesterol in all young PsA patients as soon as possible from the onset of the disease with subsequent monitoring and / or prescribing lipid-lowering therapy depending on the initial level to prevent CVD. Patients with elevated CRP, TG, LDL cholesterol should be advised to perform ultrasound of the CA to objectify the condition of the carotid arteries and early initiation of preventive medication. The frequency of re-examinations should be determined according to the degree of activity of the underlying disease, the effectiveness of basic therapy and patient compliance. Patients with high average CRP levels (over 2 years) or patients whose CRP does not decrease on the background of basic therapy (as a marker of subclinical inflammatory process) are recommended to perform ultrasound CA and determine lipid metabolism at the first visit to the doctor PMD for early preventive measures, drug therapy and further recommend monitoring of CA by ultrasound of CA every 6 months. Practical recommendations for the prevention of asymptomatic atherosclerotic CA lesions in patients with PsA in primary care were developed on the basis of a developed method for predicting the likelihood of develoing asymptomatic atherosclerotic CA lesions in patients with PsA. The use of a comprehensive assessment of traditional and additional CVD risk factors and predicting the likelihood of asymptomatic atherosclerotic CA lesions in young patients with PsA will optimize the detection of patients with high cardiovascular risk and improve the accuracy of cardiovascular prophylaxis/or treatment measures.
