Background: Rheumatoid arthritis (RA) represents the most frequent form of inflammatory arthritis affecting approximately 1% of the population worldwide. Introduction of novel therapeutic strategies targeting proinflammatory cytokines (TNF-α and interleukin-6) revolutionized the treatment of RA. This kind of treatment, although effective in a substantial portion of patients, may potentially cause many side effects. Among them cardiovascular safety is one of the main concerns. Objectives: In the present study, we investigated what impact treatment with anti-TNF-α and anti-IL-6 agents may have on heart function and levels of heart function biomarkers Methods: To measure this, we used cardiac function biomarkers such as NT-pro Brain Natriuretic Peptide, mid regional pro Atrial Natriuretic Peptide, Galectin-3 and Heart-Type Fatty Acid-Binding Protein and compared them to patients treated with methotrexate as well as healthy controls. Results: Patients treated with biologics were characterized by low disease activity or were in remission. The disease activity in these groups were significantly lower in comparison to the methotrexate group. All patient recruited to the study were characterized by normal heart function measured with the use of echocardiography (EF>50%). With the exception of MR-proANP between tocilizumab and adalimumab (median: 1.01 vs 0.49 nmol/L, p < 0.05), we failed to observe any significant differences in biomarkers levels between groups treated with biologics. Contrary to this, patients on MTX showed higher NT-proBNP levels compared to adalimumab, and healthy controls (p < 0.05 for both). Striking differences have been shown in regard to H-FABP. The levels of these biomarkers were elevated in all biologics and the methotrexate group as compared to healthy controls. Conclusion: As this biomarker reflects potential heart injury we suggest that heart damage proceeds in continuous manner in RA patients despite effective treatment and attainment of remission/low disease activity. This finding however should be verify in larger cohort of RA patients to ascertain if routine assessment of H-FABP may be useful for detection of patients with RA who are at risk of development of heart damage.
Systemic lupus erythematosus is a connective disease in which all vitally important organs may be affected. The etiology of the disease is largely unknown and almost all immunological mechanisms have been proposed as the pathophysiological background of the disease. Among them, endothelial damage and dysfunction seem to play a pivotal role. Endothelial damage can be accurately measured using adhesion molecules such asintercellular adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM), platelet endothelial cell adhesion molecule (PECAM) and selectins. In this review we discuss the role of well-known cellular adhesion molecules as pathogenic factors in disease development as well as disease activity biomarkers.
Rheumatoid arthritis is a chronic autoimmune connective tissue disease. Among all autoimmune diseases, rheumatoid arthritis is still recognised as having the most complicated pathogenesis. The importance of early diagnosis of RA and the prompt implementation of effective treatment that will lead to remission should be emphasised. The introduction of biological drugs for the treatment of arthritis at the end of the 20th century proved to be a "milestone" in rheumatology. These drugs have been targeted to stop or slow down the progression of the disease. However, not all treated patients will benefit from such treatment since a significant proportion of patients do not respond to the treatment. The study aimed to analyse in real-world clinical practice patients admitted to a typical rheumato-logical department. Patients were analysed in terms of biological treatment, age, admission procedure, gender, comorbidities, reduction in disability, as well as articular and extra-articular complications. Most of the hospitalised patients were women, married people and people living in the city. Most of the hospitalised patients are 61 to 80 years old. It is worth noting that biologically treated patients -43 people, were hospitalised more than once a year. Usually, they received biological drugs on a scheduled basis, once a month. Studies show that patients included in the drug programme have fewer mobility limitations and fewer articular and extra-articular complications. They are between the ages of 41 and 60 and have a university degree
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