BackgroundAccurate calculation of glomerular filtration rate (GFR) is an important aspect of clinical care for rheumatologic patients [1, 2, 3].ObjectivesTo choose the optimal method of determining the GFR to assess the severity of renal dysfunction in patients with rheumatoid arthritis (RA).MethodsAn open cross-sectional study was performed involving 96 patients with a reliable diagnosis of RA (mean age 54.4±11.6 years, duration of disease 10.7±8.56 years, 57.3% with moderate RA activity).For comparative assessment of renal function, we used the estimated glomerular filtration rate (eGFR) using the CKD-EPI formulas on the National Kidney Foundation website (USA): creatinine-based equation (eGFRcr), cystatin C-based equation (eGFRcyst) and calculated creatinine and cystatin C equation (eGFRcr-cyst). The 2009 CKD-EPI creatinine equation (eGFRcr) was used as a reference for comparative calculations of GFR. Based on the eGFRcr measurements, patients with RA were divided into four groups: I, >90 ml/min/1.73 m2; II, 89-60 ml/min/1.73 m2; III, 45-59 ml/min/1.73 m2; and IV, <45 ml/min/1.73 m2.ResultsThe mean eGFRcr, presented as a reference in this study, was 70.0±18.7 ml/min/1.73 m2. Signs of hyperfiltration using eGFRcr (>90 ml/min/1.73 m2) were observed in 16 (10.1%) patients with RA, mild decrease of renal function (60-89 ml/min/1.73 m2) was registered in 52 (32.9%), moderate/severe decrease (<59 ml/min/1.73 m2) - in 28 (17.8%) patients with RA. Decreased eGFRcr was differentially associated with increased patient age (r=0.46; p=0.003), disease duration (r=0.24; p=0.017), cumulative dose of hormones (r=0.66; p=0.007), lower height (r= 0.35; p=0.001).Analysis of eGFR values demonstrated significant differences using the selected methods (χ2=9.91, p= 0.007). Intergroup differences (in degree of decrease in eGFR) were statistically significant for all variants of eGFR calculation (eGFRcr, eGFRcyst, eGFRcr-cyst; H-test and Median-test, p<0.001). According to the eGFRcr formula, an absolute majority of patients with RA (83.3%) had a decrease in GFR of varying severity (a slight decrease was registered in 54.2% of cases) (Table 1).Table 1.Group distribution of RA patients according to eGFR, n(%)Group IGroup IIGroup IIIGroup IVeGFRcr16 (17.0)52 (54.2)20 (20.8)8 (8.33)eGFRcr-cys22 (22.9)39 (40.6)20 (20.8)15 (15.6)eGFRcyst29 (30.2)29 (30.2)22 (22.9)16 (16.7)The use of eGFRcyst showed that only 12 of 29 people in the first group had optimal (>90 ml/min/1.73 m2) eGFRcr (p=0.031), and 17 patients entered the group with slightly decreased (60-89 ml/min/1.73 m2) eGFRcr. A similar, but less significant situation (12 of 22 people and 10 patients, p=0.02) was also observed with eGFRcr-cyst. In the second group of RA patients 19 patients corresponded to the chosen criteria in determination of eGFRcyst, and 8 patients entered groups (III and IV) with more severe decrease of renal function (2 patients were included into group I) (p=0,011). Significant differences in this group were also noted when comparing the proportions according to eGFRcr with eGFRcr-cyst (p=0.044). A probable decrease in renal filtration function with eGFRcr (compared with the alternative use of eGFRcr-cyst or eGFRcyst) can be observed in 11-18% of RA patients in group 1 (high/optimal renal function) and up to 10% of RA patients in group 2 (slight decrease). No significant differences were found using the three estimated CKD-EPI formulas in RA patients with moderate/significant decrease in GFR (p>0.05).ConclusionCurrently, the overall diagnostic performance of the CKD-EPI equation based on creatinine and cystatin C may be the most optimal (in comparison with other calculated CKD-EPI formulas) in patients with RA, and may also be useful for confirming eGFRcr results >60 ml/min/1.73m2.References[1]Saisho K. et al. Mod Rheumatol. 2016;26(3):331-5.[2]Couderc M. et al. Arthritis Care Res (Hoboken). 2016;68(5):638-44.[3]Aleksandrov V. et al. Ann Rheum Dis. 2021;80(S1):1059. doi:10.1136/annrheumdis-2021-eular.2275.Disclosure of InterestsNone declared
BackgroundEpidemiological data and clinical observations suggest an increased risk of depressive disorders in rheumatoid arthritis (RA) patients with metabolic syndrome (MS) [1, 2].ObjectivesTo study the prevalence of depressive symptoms depending on the presence of MS components in RA patients and to evaluate their combined effect on achieving remission of RA.Methods100 RA patients aged 18 to 69 years old (91% women; mean duration of disease 9 [3.5;15] years; body mass index (BMI) 28.8 [IQR 25.1-32.8]) were examined. MS was confirmed in RA patients with three or more harmonized National Cholesterol Education Program/ Adult Treatment Panel III (NCEP/ATPIII; 2004) criteria. RA patients were assigned a binary MS score (“yes/no”) and a categorical MS score (from 0 to 5 criteria) was calculated. The severity of depression in patients with RA was determined using the Beck Depression Inventory (BDI).Results46% of RA patients met the criteria for MS. The presence of three categorical signs of MS was noted in 26%, four - in 16% and of all five signs - in 4% of cases. The combination of elevated fasting glucose, elevated triglycerides (TG), and decreased high-density lipoproteins (HDL) was the most frequent (19.6%; 9/46). The combination of the four MS criteria (increased waist circumference (WC), elevated TG, decreased HDL, and arterial hypertension) occurred in 17.4% (8/46) of cases. RA patients with MS had more severe systemic inflammation (C-reactive protein 9.3[3.9; 23.1] versus 3.35[2.3; 12.0] mg/L, p=0.028), higher levels of TG (p=0.001) and total cholesterol (p=0.003), and higher BMI (p=0.018) and WC (p=0.007).Depression scores of BDI ≥10 were noted in 64 RA patients: 26% were mild, 28% were moderate and 10% were severe. Symptoms of depression were more frequent in RA patients with longer duration (β=0.25, p=0.012) and high activity (β=0.37; p=0.001) of the disease. There were statistically significant differences in the incidence of depression (BDI ≥10 points) depending on the absence or presence of MS in RA patients (Phi-square=0.42; association coefficient φ=0.65). When comparing groups of RA patients stratified by the presence of MS, significant differences in the severity of depressive disorders according to BDI were found (RA without MS: 8,35 ± 5,1 points; RA with MS: 23,6 ± 12,8 points, p < 0,001). In RA patients without MS, only mild (26%) and moderate (9.3%) depression were detected. In RA patients with MS, depressive symptoms from mild to severe were present in almost equal poportions. Two-factor analysis of variance showed no significant effect of BDI and MS on DAS28-ESR activity in RA patients (p>0.05). The presence of MS had a significant effect on BDI depression (p<0.001), and there was no relationship between MS and the degree of disease activity (p=0.33).Re-examination (6-7 months later) of patients with initially moderate RA activity (n=58) revealed that remission of the disease was not achieved in 25% of patients from the group with no signs of depression and MS. In the group of RA patients with MS and BDI ≥10 there were almost 2.5 times more cases of deterioration (63.3%) (χ2 with Yates correction = 4.7, p=0.03).ConclusionProgression of depression against the background of marked metabolic disorders can lead to a decrease of RA patients’ quality of life and complicate disease prognosis [3, 4, 5]. This requires an early multidisciplinary treatment and increased knowledge of the risks associated with depression and MS among health care professionals and patients. Identification and correction of symptoms of depression and MS in RA patients should be a part of the optimal patient care.References[1]Santos EF et al. Clin Exp Rheumatol. 2019;37(4):641-648.[2]Kwiatkowska B et al. Reumatologia. 2018;56(4):219-227. doi: 10.5114/reum.2018.77973[3]Aleksandrov A, Aleksandrova N. Ann Rheum Dis. 2021;80(S1):1110. doi: 10.1136/annrheumdis-2021-eular.3087[4]Zhang L et al. Int J Rheum Dis. 2020;23(3):285-293. doi: 10.1111/1756-185X.13774[5]Chaurasia N et al. J Family Med Prim Care. 2020;9(4):1974-1980. doi: 10.4103/jfmpc.jfmpc_1161_19.Disclosure of InterestsNone declared
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