BackgroundAccording to recent national and EULAR recommendation cardiovascular risk (CVR) in pts with RA should be evaluated using modified SCORE system. But a lot of investigations and real clinical data demonstrate that this system commonly down-estimates CVR in RA pts.ObjectivesAim of our study was to compare standard CVR assessment and additional CVR evaluation on the basis of specific disease-associated risk factors (RF) and CV system investigations in long standing RA.Methods118 pts (96 female, 22 male) aged from 34 to 74 years old (mean age 55.91±5.21) with long standing RA (duration >5 years) were observed. In all pts CVR was stratified according to modified SCORE. We have analysed pts medical cards and standard examination data to determine clinical features of RA and associated conditions to verify severity of CVR. In term to reveal asymptomatic CV disease pts had undergone additional investigations (echocardiography, Dopplerography of carotid arteries, ECG-monitoring).ResultsConventional CVRF were registered in 110 (93.22%) pts. Age>45 (male),>50 (female) was in 85 (72.03%) pts, BMI>25 kg/m2; in 10.17%, elevated cholesterol level and/or dyslipidemia in 41.52%, AH with target organ damage was detected in 45.76%, T2DM in 11.8%, CKD 3 stage in 10.17%, history of MI was in 2 (1.69%) pts. According to modified SCORE for RA very high, high, moderate and low CVR was detected in 17.80%, 47.46%, 18.64%, 16.10% cases respectively. High activity of RA was diagnosed in 61.02%, and erosive arthritis in 84.75% pts. Inadequate disease-modifying treatment was qualified in15.26% cases. Majority of pts (59.32%) received systemic glucocorticoids (GC) in daily doses from 2 to 12 mg of methylprednizolon, among these pts 14 (11.86%) have been taken GC in moderate and high dose for a long period. On the basis of instrumental data asymptomatic atherosclerosis of aorta and/or aortic valve and/or carotid arteries was detected in 44 pts (37.29%). Silent ischemia was revealed in 3 pts (2.54%). High disease activity and long term systemic GC treatment were associated with significantly high CV events in observed pts (p<0.05). Using obtained results we reassessed CVR in studied cohort. Revised data of CVR stratification suggest that 49 (41.53%) pts were in VH-CVR, 41 (34.75%) – in H-CVR, 16 (13.56%) in M-CVR and only 12 (10.17%) in L-CVR. The difference in pt ratio for CVR stratification was significant in accordance with χ2; criterion.ConclusionsObtained data suggest that modified SCORE is not absolutely reliable tool for precise CVR stratification in long standing RA. Additional investigations to define asymptomatic atherosclerosis and coronary artery disease are required in term to prevent CV complications especially in pts with high active erosive RA treated with systemic GC.Disclosure of InterestNone declared
Background:Patients with rheumatoid arthritis (RA) are in increased risk of developing comorbid conditions. Recent data suggest the relationship between severity of RA and concomitant diseases [1, 2]. Drug therapy is considered as impotent risk factor for numerous comorbidities. On the other hand comorbidity can impact negatively on the RA course and on the pts management [3].Objectives:The aim of our study was to evaluate the prevalence of concomitant conditions in RA pts, to compare the RA activity and management in relation with comorbidities.Methods:168 pts with established and longstanding RA were observed at in-patient clinic for RA clinical assessment and revealing concomitant diseases (cardiovascular, gastrointestinal, liver, pulmonary, endocrine, blood). The activity of disease according to DAS28-ESR index in RA subgroups with different comorbidities was compared. The spectrum and used doses of anti-rheumatic medications (DMARD, biologics, GC) in these subgroups was analyzed in term to assess the RA rational treatment.Results:The majority (88.1%) of observed RA pts had concomitant condition. The most frequent associated diseases were: cardiovascular (AH, IHD, HF, AF) in 86.9% and gastrointestinal (gastritis, duodenitis, gastroduodenal ulcer, colitis) in 64.3% less common comorbidities were anemia (30.9%), liver and kidney abnormalities (hepatomegaly, steatohepatitis, CKD, pyelonephritis) in 25% and 12.5% respectively, endocrine (type 2 diabetes mellitus, thyroid disorders) in 16.7%. Multimorbidity determined as combination of different system disorders in the setting of RA was detected in 54.8% of RA pts. We found out significant difference in RA activity on the basis of DAS28 between RA subgroup without concomitant conditions (the 1st) on the one hand and RA subgroups with comorbidities (the 2nd) (t1=2.76, p<0.01) or multimorbidities (t2=3.73, p<0.01) on the other hand (tab.1).IndexRA without comorbidities (1stgroup)RA with comorbidities(2nd group)RA with multimorbidities(3d group)DAS 284.20 ±0.315.09±0.095.44±0.12In RA with comorbidities/multimorbidities the mean doses of MTX and SSZ were lower than in RA without comorbidities, while the dose of GC and frequency of GC use was significantly higher in the 2nd and 3d groups (χ=4.25, 4.41 respectively). 55% of pts from the 1st group and only 19.6% of total amount of pts from the 2nd and 3d groups were treated with biologics (χ=5.67).Conclusion:Obtained data suggest that comorbidities have a negative impact on the severity of RA and can interfere in the implementation of T2T strategy in daily clinical practice.References:[1] Dougados M, Soubrier M, Antunez A, Balint P, Balsa A, Buch MH, et al. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis (2014) 73(1):62–8. doi:10.1136/annrheumdis-2013-204223[2] Radner H. Multimorbidity in rheumatic conditions. Wien Klin Wochenschr (2016) 128(21–22):786–90. doi:10.1007/s00508-016-1090-x[3] Radner H, Yoshida K,...
The complexity of timely diagnosis of giant cell arteritis (GCA), as the most common form of systemic vasculitis in the elderly, is due to the nonspecificity of clinical manifestations and the absence of specific immunological markers. New difficulties arise during the period of coronavirus infection, which manifests itself in similar syndromes and at the same time can provoke immuno-inflammatory rheumatic disease. In this regard, it is extremely important to make a correct differential diagnosis between persistent viral infection and the development of systemic vasculitis. This article presents a clinical observation demonstrating the complex process of diagnosis and differential diagnosis of GCA in the conditions of the COVID-19 pandemic. The patient was hospitalized due to a confirmed coronavirus infection. However, despite the standard therapy and the achieved eradication of the coronavirus, the symptoms characteristic of GCA and polymyalgia rheumatica (PR) persisted. A precision analysis of the clinical picture allowed us to establish that the typical manifestations of GCA and PR occurred in the period preceding COVID-19 infection. Subsequent in-depth examination made it possible to verify the diagnosis of GCA and PR based on the current classification criteria. The therapy with glucocorticoid and methotrexate made it possible to achieve remission. The presented observation will help to raise awareness of general practitioners and related specialties about the need to rule out GCA and PR in the case of prolonged unexplained fever, myalgia, headache, joint pain and swelling, transient visual disturbances, jaw claudication in elderly patients in the setting or after coronavirus infection.
Министерство науки и высшего образования Российской Федерации Федеральное государственное бюджетное научно е учреждение «Научно-исследовательский институт клинической и экспериментальной ревматологии имени А.Б. Зборовского» Федеральное государственное бюджетное образовательное учреждение высшего образования «Волгоградский государственный медицинский университет» Министерства здравоохранения Российской Федерации
The article contents the analysis of different clinical phenotypes in the most common spondyloarthritis (SpA): ankylosing spondylitis (AS), axial spondylarthritis (axSpA) and psoriatic arthritis (PsA). SpA polymorphism has been discussed on the basis of multiple clinical presentations, structural lesions, radiological, immunological and genetic characteristics. Role of pro-inflammatory agents especially IL-17 in structural progression has been pointed out. Recent data regarding the link between HLA-B27 antigen, gender and age specificity and different clinical manifestation of SpA are presented. Current algorithms for SpA management based on evidence of efficacy sDMARD and/or biologics in separate phenotypes of SpA as well as resistance to DMARD are highlighted. Authors have concluded that meticulous analysis of SpA manifestation and patient’s individual profile is critical in rational SpA management according to personified medicine strategy.
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