FRI0063 LEVEL OF N-TERMINAL FRAGMENT OF BRAIN NATRIURETIC PEPTIDE PROGENITOR AND ATHEROSCLEROTIC DAMAGE OF BRACHIOCEPHALIC ARTERIES IN PATIENTS WITH EARLY AND LONG-STANDING ACTIVE RHEUMATOID ARTHRITIS
Authors: H. Gerasimova, T. Popkova, M. Cherkasova, E. Markelova, S. Glukhova, I. Kirillova, D. Novikova, A. Lila
Journal: Annals of the Rheumatic Diseases (2020)

Background: The high prognostic significance of the N-terminal fragment of the B-type natriuretic peptide (NT-proBNP) concentration in the development of cardiovascular diseases (CVD) was identified for rheumatoid arthritis (RA) patients (pts) and general population. Objectives: To investigate the significance of NT-proBNP levels in pts with early untreated and long-standing RA with high disease activity; to identify potential relationship of NT-pro-BNP levels with atherosclerotic lesion of the brachiocephalic arteries (BCA), traditional risk factors and inflammatory markers. Methods: A total of 227 RA pts (76%females, 24%males, 55 [46;61]years old, moderate to high activity (DAS28-5,3[4,6;6,3], SDAI–27(22;35), positive for ACCP (73%)/RF (87%),) were enrolled in the study: 136 pts with early RA (disease duration ≤12 months) and 91 pts with long-standing RA (&gt;12 months). All early RA pts were not treated with glucocorticoids and disease-modifying antirheumatic drugs (DMARDs). Long-standing RA pts already developed the lack of efficacy/resistance and/or intolerance of DMARDs. Lack of efficacy of 3 or more DMARDs was established in 46% of pts, intolerance to previous DMARDs therapy - in 54% pts. 73% were receiving methotrexate, 21% - leflunomide, 7% - sulfasalazine, 46% glucocorticoids. Pts with early and long-standing RA were comparable in terms of age, sex, body mass index and RA activity rates (DAS28, SDAI, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels). High incidence of traditional risk factors was found in early and long-standing RA pts: the incidence rate of arterial hypertension (58%vs68%), overweight (58%vs61%), smoking (27%vs17%), DM type 2 (4%vs7%) were not significantly different. Pts with congestive heart failure were not include in the study. The control group consisted of 20 healthy donors, matched to pts by age and sex. Serum levels of NT-proBNP (pg/mL) were measured using electrochemiluminescence test Elecsys proBNP II (Roche Diagnostics, Switzerland). NT-proBNP levels &gt; 125,0 pg/mL were considered as elevated. The BCA intima-media thickness (IMT) was assessed by duplex ultrasound scanning. Atherosclerotic lesion of BCA was documented in the presence of plaque (IMT≥1,2mm). Results: The NT-proBNP levels were significantly higher in RA pts than in the control group (median 92,1 (48,2-164,7) pg/mL vs 55,3 (36,6-67,3) pg/mL, p &lt;0.05). Pts with early RA had higher NT-proBNP levels (118,9 (60,2-201,3) pg/ml) than pts with long-standing RA (73,4 (43,0-114,3) pg/ml, p &lt;0,001). Elevated NT-proBNP concentrations were found in 71 (52%) early RA pts vs 21 (23%) pts with long- standing RA ( р &lt;0,01). Atherosclerotic lesion of the BCA was detected in 73 (54%) pts with early RA and in 37 (41%) pts with long- standing RA ( p &gt;0,05). The NT-proBNP levels correlated with age (r=0,51, p &lt;0,001), CRP (0,23, p =0,001) and IMT of BCA (r=0,46, p =0,03) in RA pts. Aforementioned correlations were significantly remained for both groups of RA pts. Association between IMT of BCA and CRP concentrations was not found. Conclusion: NT-pro-BNP levels are higher in pts with active RA than in control subjects. Early untreated RA pts had a higher NT-proBNP levels than pts with disease duration &gt;12 months and resistance or intolerance of DMARDs. The increased concentration NT-pro-BNP (&gt;125pg/ml) were found in half of pts with early untreated RA and every fourth pts with long-standing active RA. NT-proBNP concentration correlated with CRP level in pts with active RA. Correlation between NT-pro-BNP concentrations and IMT of BCA may be indicative of possible impact of this biomarker on atherosclerotic damage of BCA in pts with early and long-standing active RA. Disclosure of Interests: None declared