Сhronic heart failure associated with rheumatoid arthritis: role of inflammation in changing the level of atrial sodium uretic peptide and lipidogram indicators
Authors:   Irkutsk State Medical University, Ankudinov A.S. , Kalyagin A.N. ,   Irkutsk State Medical University
Published: December 2020

The aim of the research is the analysis of basic clinical laboratory and instrumental parameters of patients suffering from CHF with intermediate left ventricular ejection fraction (LEF), developed as a result of ischemic heart disease and arterial hypertension associated with RA compared to patients without RA; assessment of indicators of morphological and functional parameters of myocardium and possible associations with indicators of RA inflammation activity. Material and methods. The study group included 134 patients with HFFV associated with RA; the comparison group was of 122 patients with HFFV without RA. CHF functional class of patients who took part in the study according to NYHA I-II. RA was diagnosed based on X-ray and serological studies, which included determination of rheumatoid factor (RF), antibodies to cyclic citrullinated peptide (ACCP), C - reactive protein (CRP). Inflammatory process activity was assessed by DAS28 index and visual analogue pain scale (VAS). X-ray RA stage included the studied I-III patients according to Steinbrocker classofication. CHF treatment medications were compared in groups. The basic anti-inflammatory medication for RA treatment is methotrexate. Patients who did not take methotrexate due to side effects and / or individual intolerance took leflunomide at a dosage of 20 mg per day. Moreover, NSAIDs were used (enterally, parenterally, locally). Hematological, biochemical and instrumental studies were carried out. The processing was carried out in STATISTICA 10.0 program. The work presents statistically significant results. The critical level of significance when testing statistical hypotheses is p <0.05. Results. Comparative analysis revealed statistically significant differences in the levels of ESR and CRP, with a predominance of values in the study group, which naturally reflects the intensity of inflammatory process. Furthermore, statistically significant differences in the levels of creatinine and GFR were revealed. It can be due to the influence of chronic inflammation and regular intake of NSAIDs. In the group of patients with CHF on the background of RA, statistically significant decrease in hemoglobin level was found. Statistically significant predominance of TG, LDL-C concentration, as well as a decrease in HDL-C in the study group in relation to the comparison group were obtained. Statistically significant predominance of atherogenic coefficient was revealed in the study group. NT-proBNP concentration in the study groups differed significante: in the group of patients with CHF associated with RA, the level was 306.7 (225; 391) pg / ml; in the CHF group without RA - 488.7 (355; 638) (p = 0.02). A direct association of the DAS28 index and NT-proBNP was found (r = 0.04; p = 0.02). Conclusion. Patients with CHF associated with RA are reasonably recommended to increase the dosage of statins with more frequent monitoring of lipid profile. An assessment of NT-proBNP level is required for more detailed assessment of morphological and functional parameters of myocardium.