Background Lesion of the cardiovascular system is associated with uncontrolled inflammation and immune defects in patients with Rheumatoid Arthritis (RA). There is an evidence of the close pathogenetic connection between rheumatoid inflammation and accelerated development of atherosclerosis. The first sing of atherosclerosis is endothelial dysfunction (ED).
Objectives Evaluate the effectiveness of NO donators (4,2% solution of arginine hydrochloride and L-arginine aspartate) in the correction of lipid and ED in patients with RA and secondary Raynaud's syndrome (RS).
Methods 68 patients with RA were examined. All patients were divided into 2 groups: (37 people with RA in combination with secondary RS) received basic therapy of RA (methotrexate 10–15 mg/wk.), antiplatelet and vasodilatory drugs; II group (31 people – RA in combination with secondary RS) got similar therapy plus NO donators (4,2% solution of arginine hydrochloride and L-arginine aspartate). The examination was carried out at the patient's admission to the hospital and the hospital and 3 months after the beginning of treatment. Endothelial function was assessed by determining the flow-mediated vasodilation of brachial artery (FMD), levels of endothelin-1, rheumatoid factor (RF), C-reactive protein (CRP), lipid profile (total cholesterol – TC, low density lipoprotein – LDL, high-densitylipoprotein – HDL and triglycerides – TG), index of intima/media (IM) and atherogenic index (AI).
Results Levels of TC, LDL, AI and MI indexes were significantly higher than the norm in 2 compared groups before the treatment and 3 months after its start (p<0,05). There were significant decreases in levels of lipid profile, IA and MI index in II group 3 months after treatment in comparison to benchmarks (TC by 13,3%, LDL by 16,1%, TG by 14,7%, AI index by 13,8% MI index by 12,7%,p<0,05) and they were significantly unchanged in I group (p<0,05). It was elucidated a direct reliable strong correlation in patients of II group between the level of FMD and endothelin-1 before treatment (r=0,73, p<0,05) and after treatment (r=0,69, p<0,05). Symptoms of ED, levels of endothelin-1, RF, CRP were decreased in patients of both groups after the conducted therapy. It was established a proportionately reliable correction between CRP and LDL levels after treatment in II group of patient (r=0,63, p<0,05).
Conclusions 1.There is a lack of flow-mediated vasodilation of brachial artery in patients with RA and secondary RS, which can indicate a dysregulation of endothelial function.
2. The level of CRP is increased in patients with RA and secondary RS and is associated with the risk of hyperlipemia and atherosclerosis. 3. The usage of NO donators (4,2% solution of arginine hydrochloride and L-arginine aspartate) in the treatment of RA with secondary RS significantly reduces the levels of IA and IM index, the level of atherogenic lipoprotein fractions (TC, LDL and TG) and decreases the severity of ED, which leads to minimizing the risk of atherogenesis and its complications.
Kuryliszyn-Moskal A, Klimiuk PA, Sierakowski S, Ciolkiewicz M. A study on vascular endothelial growth factor and endothelin-1 in patients withextra-articular involvement of rheumatoid arthritis // ClinRheumatol. 2006 May; 25 (3): 314–9.
Disclosure of Interest None declared