Background The main cause of high mortality of RA patients is early formation and progression of atherosclerotic lesion in vessels, leading to an increased risk of myocardial infarction, congestive heart failure, stroke, and sudden death. A similar profile of the immune response is the activation of T-cells and mast cells, the production of proinflammatory cytokines, increased levels of α-metalloproteinase; the identity of cellular composition of an atherosclerotic plaque and the inflammatory infiltrate in synovium with RA; correlation between the level of C-reactive protein (CRP), ESR, cytokines (especially Interleukin-6 (IL-6)), cell adhesion molecules and blood lipid spectrum (HDL-C, apoA1) – all these indexes help to explain the high frequency of atherosclerosis manifestations in RA patients.
Objectives Identify blood lipid profile disturbances in patients with a high activity of rheumatoid arthritis.
Methods The study is based on the follow-up results of 48 RA patients under treatment at the Republican Centre of Rheumatology attached to Tashkent Medical Academy. Criteria for inclusion of patients in the study were – RA diagnosis, verified in accordance with the ACR/EULAR (2010) criteria, active RA, the informed consent to participate in the study. All patients had a high disease activity defined by DAS28. Activity indexes ranged from 5.11 to 8.29 and averaged 6.44. Analysis of the blood lipid profile was based on optimum values: total cholesterol (TC) – less than 5 mmol/l (193.4 mg/dl), low-density cholesterol (LDL) – less than 3 mmol/l (116.0 mg/dl), high-density cholesterol (HDL) – greater than 1.2 mmol/l (46.4 mg/dl) for women and more than 1 mmol/l (38.7 mg/dl) for men, triglycerides (TG) – less than 1.77 mmol/l (68.4 mg/dl).
Results The average age of RA patients was 49.7 years (ranged from 36 to 72), the average RA duration was 8.2 years (ranged from 1 to 22 years). The dyslipidemia was revealed in 37 patients of the study group, amounting to 77.1%. TC level increase have been reported in 31 out of 48 (64.6%) cases and was associated with an imbalance of other components of the lipid profile. The average TC value was 5.8 mmol/l (224.28 mg/dl). Increased TG levels have been reported in 11 of 48 cases (22.9%), reduced HDL - in 27 out of 48 (56%) cases. The average TG level – 1.8 mmol/l (69.6 mg/dl), HDL – 1.1 mmol/l (42.5 mg/dl). The most significant was increase in LDL – revealed in 35 patients (72.9%). Mean LDL – 3.9 mmol/l (150.8 mg/dl). Most of the patients had type II hyperlipidemia (highly atherogenic): IIa – 23 (47.9%), IIb - 7 (14.6%).
Conclusions Results of our investigation showed the presence of a coarse lipid imbalance in patients with highly active RA. The most expressed imbalance was the increase in TC and LDL. Similar violations observed in the majority of patients are associated with a highly atherogenicity in RA and a high risk of cardiovascular events.
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Disclosure of Interest None declared