SAT0135 Cytokine activation and formation of nephropathy in early rheumatoid arthritis: clinical and pathophysiological parallels
Authors: D. Rekalov, G. Prytkova, R. Kulynych
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> RA is characterized by not only joints destruction, but also of other organs and systems, particularly, lungs, heart, blood vessels, kidneys, etc. Nephropathy is currently the leading symptomatic complex of Rheumatoid Arthritis (RA), with upto 73% frequency, being identified as a prognostic criterion of diseaseseverity and outcome. The development of renal insufficiency, as a rule, is the main cause of the fatal outcome of RA without possibility of regular hemodialysis to such patients. <h3>Objectives</h3> of the study are to determine pathophysiological relation between cell-mediated immunity (tumornecrosis factor-alpha (TNF-α)) activation and renal dysfunction in the patients with early RA (eRA). <h3>Methods</h3> We analyzed the datafrom 35 early RA patients of average age of 50,71±2,25 years (ranged 18 - 76years, 80% of women) with 9,21±0,43 months mean duration of the disease by the time of the study initiation. Urine and blood tests were performed to verify the main indicators of kidney function and inflammation cytokines significant interaction. <h3>Results</h3> All signs of renaldys function at the baseline in the patients with eRA were associated with glomerular filtration rate decrease and excretion of urine protein increase. Dynamics of albumin urine, according to the analysis of variance for one-factorscheme, were significantly determined by the state of disease activity,reflecting the severity of joint damage. High urine β-2-microglobulin level wassignificantly associated with the expression rate of main inflammatorycytokines as per binary regression analysis. <h3>Conclusions</h3> The obtained dependence showed the dynamics of expression of tubular disorders in early RA with a progressive deterioration which did associate with the levels of TNF-α expression, and variety of the urine miсroglobulin rates in the interval 200-350 μg/L. Reliable correlation (r=0.51, p&lt;0.05) between beta-2-microglobulinuria and TNF-α levels was clearly shown, revealing the relationship described by the formula MGU = - 481 + 937 × log10 (TNF-α) as per regression analysis. The severity of tubular damage in early RA is associated with TNF-α expression, especially in the patients with TNF-α above 250 pg/mL,when microalbumin urine rates were significantly higher (p=0.00043). We identified robust data that in the early RA patients with high TNF-α, the number of reported cases of microalbumin urine was significantly higher than in those with low levels. <h3>References:</h3> [1] Kizaki K, Yamashita T, Hayashi et al. Infliximab is equivalently suppressingoxidative stress compared to tocilizumab among well-controlled patients withrheumatoid arthritis. Int J Rheum Dis 2016. doi: 10.1111/1756-185X.12972 [2] Isaacs JD, Zuckerman A, Krishnaswami S, et al. Changes in serum creatinine inthe patients with active rheumatoid arthritis treated with tofacitinib: resultsfrom clinical trials. Arthritis Res Ther 2014;16(4):158. doi: 10.1186/ar4673 <h3>Acknowledgements:</h3> No Acknowledgements. <h3>Disclosure of Interest:</h3> None declared