The work evidences that an early onset and a longer period of RA are connected with an early development of comorbid CCS among the patients in Bukovyna population found in this group of patients at an early age – under 45 years. Even with similar amount of edematous joints in patients from the both experimental subgroups, different amount of painful joints and increased ESR are found to be a sign of an adequate contribution of painful and inflammatory components in a higher index of the activity of DAS 28 diseases in patients with comorbid pathology.
A high percentage of patients with hyperlipidemia is found among the individuals suffering from RA without comorbid cardio-vascular diseases (CVD), as well as with comorbid RA + CCS. An increased level of low-density lipoproteins (LDL) is most often diagnosed. Reliably higher indices of total cholesterol and LDL in the blood and a reliably lower content of high-density lipoproteins (HDL) are found in patients with RA and comorbid CCS in comparison with those suffering from RA. These changes are more pronounced among those patients who suffer from RA about 10 years, that is, a longer period of the disease neutralizes this difference. Atherogenicity index of 3.5 and higher in patients of the young and middle ages with comorbid RA and CCS is proved to be indicative of a higher risk of development of CVD complications among these age groups.
Lower self-assessment of the state of health is found to be specific for the patients with comorbid RA and CCS, and it deteriorates additionally with age and when the period of the underlying disease becomes longer. According to HAQ index, patients with RA and CCS have more considerable restriction of physical functions. The percentage of patients with substantial functional disorders in this population is higher than in those with isolated RA. Comorbidity of RA with CCS does not affect so much a physical component of patients’ lives, but it deteriorates considerably a psychic component of patients’ lives promoting their social disadaptation, development of anxiety and susceptibility to depression. It also produces a negative effect on patient’s perception of the outcome of his future treatment.
Reliably higher heart rate (HR) is registered in patients with RA and CCS in comparison with those individuals who suffer from CCS only. Reliably higher indices of HR were found in patients from the group with RA and CCS in comparison with the patients from the group with CCS only. Thus, HRmin was 3,1% higher, HRmean –12,73% higher, and HRmax – 11,6% respectively. Comparison of the spectral analysis of the heart rate variability (HRV) indicates more pronounced decrease of the general spectrum power (34,82%, р<0,001), high frequency constituent of the spectrum (15,94%, р<0,05) in patients with comorbid RA and CCS, which correlates with the indices of activity and duration of RA. The episodes of both painful and painless myocardial ischemia were registered reliably more often among these patients as well – 23.21% and 36.62% respectively. At the same time, the ration of episodes of painless myocardial ischemia and painful myocardial ischemia in RA + CCS patients was higher (1,6) than the similar index in the group of patients with CCS. Duration of episodes of painful and painless myocardial ischemia appeared to be longer in patients with comorbid course of RA and CCS.
Additional administration of L-lysine in the complex of therapy promotes quicker regress of clinical signs in patients suffering from RA, and its action is better manifested in the group of RA + CCS patients. Modification of treatment by means of addition of L-lysine escinate to the therapeutic complex is accompanied by manifestation of a moderate hypolipodemic effect with improvement of levels of general cholesterol, LDL, triglycerides in patients. Additional administration of L-lysine in the complex of therapy decreases the level of the pro-inflammatory marker VEGF in this group of patients. Anti-rheumatic therapy influences on sCD28 content in the blood of patients with RA, and 22.0% decrease of the index both, in the main group and the group of comparison, may be indicative of achievement of stabilization of the immune response in patients from both groups.
