EVALUATION OF EFFECTIVENESS OF INFLUENCE OF THE SUBCUTANEOUS FORM OFMETHOTREXATUM TO THE LEVEL OF PRO-INFLAMMATORY CYTOKINEMIA AND THE MORPHOFUNCTIONAL STATE OF VASCULAR WALL IN PATIENTS WITH RHEUMATOID ARTHRITIS
Department of internal Diseases №1, Kursk State Medical University, Kursk, Russia
Department of Propedeutics of Internal Diseases, Avicenna Tajik State Medical University, Dushanbe, Tajikistan
Objective: To assess the effect of the subcutaneous form of methotrexatum (metoject) on the level of pro-inflammatory cytokinemia and the morphofunctional characteristics of the vascular wall in patients with rheumatoid arthritis.
Methods: The level of pro-inflammatory cytokinemia and the morphofunctional characteristics of carotid arteries were studied in 94 patients with rheumatoid arthritis (RA) positive for RF-IgM and/or anti-citrullinated protein antibody (ACPA).
Results: It has been established that in patients with RA as a result of an increase in the serum concentration of pro-inflammatory cytokines (TNF-α, IL-1β, IL-6) the subclinical lesion of the major arteries, manifested by an increase in the thickness of the intima-media complex (IMC) and the stiffness index of the common carotid artery (CCA) was observed, the magnitude of which was correlated with the duration of RA, the activity index of DAS28, the level of RF and the concentration of ACPA. The use of metoject in RA patients led to a statistically significant decrease in the DAS28 index, a decrease in pro-inflammatory cytokinemia with attainment of control values in the early stages of the disease, a decrease in the thickness of IMC of the CCA, and local (carotid) rigidity of the vascular bed, which is more pronounced with RA duration less than 2 years. It was demonstrated that metoject therapy along with high anti-inflammatory activity, possesses a vasoprotective effect, which is characterized by a decrease in remodeling signs of CCA.
Conclusions: The results of the study confirm not only the high clinical efficiency and good tolerancy of the subcutaneous form of metoject, but also show that it possesses a high anti-inflammatory activity, which provides a vasoprotective effect on large vessels of the elastic type (aorta and common carotid arteries).
Keywords: Rheumatoid arthritis, methotrexatum, metoject, thickness of intima-media complex, common carotid artery,, pro-inflammatory cytokines.
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Knyazeva Larisa Aleksandrovna, Doctor of Medical Sciences, Full Professor, Professor at the Department of Internal Diseases № 1, Kursk State Medical University
Saidov Yor Umarovich, Doctor of Medical Sciences, Head of the Department of Propedeutics of Internal Diseases, Avicenna Tajik State Medical University
Knyazeva Larisa Ivanovna, Doctor of Medical Sciences, Full Professor, Head of the Department of Internal Diseases № 1, Kursk State Medical University
Mahmudov Hayom Ruziboevich, Assistant at the Department of Propedeutics of Internal Diseases, Avicenna Tajik State Medical University
Meshcherina Natalya Sergeevna, Doctor of Medical Sciences, Associate Professor at the Department of Internal Diseases № 1, Kursk State Medical University
Goryaynov Igor Ivanovich, Doctor of Medical Sciences, Full Professor, Professor at the Department of Internal Diseases № 1, Kursk State Medical University
Stepchenko Marina Aleksandrovna, Doctor of Medical Sciences, Full Professor, Professor at the Department of Internal Diseases № 1, Kursk State Medical University
Nikulina Irina Mihaylovna, Post-graduate student at the Department of Internal Diseases № 1, Kursk State Medical University
Kudinova Irina Sergeevna, Post-graduate student at the Department of Internal Diseases № 1, Kursk State Medical University
Address for correspondence:
Knyazeva Larisa Aleksandrovna
Doctor of Medical Sciences, Full Professor, Professor at the Department of Internal Diseases № 1, Kursk State Medical University
305007, Russia, Kursk, Sumskaya Street, 45-а
Tel.: (+7) 910 310 2827