AimTo investigate differences in body composition and body mass index (BMI) in patients with rheumatoid arthritis (RA) and their correlations with serum production of adiponectin, interleukin-6 (IL-6), and vascular endothelial growth factor (VEGF).MethodsThe study included 83 patients (age 53 ± 5 years) with RA treated with methotrexate. We determined their BMI, fat mass, and fat-free mass using bioimpedance analysis, and serum concentrations of adiponectin, VEGF, and IL-6 using immunoassay analysis.ResultsNormal BMI was found in 39 (47%), overweight and obesity in 26 (31%), and underweight in 18 (22%) patients. Concentration of adiponectin was lower in overweight/obese patients than in patients with normal BMI (2.1 [0.8-3.9] μg/mL vs 8.9 (7.2-11.3) μg/mL). In underweight patients, it was moderately increased (12.7 [9.3-14.8] μg/mL) and the correlation between the concentrations of adiponectin and IL-6 was positive (r = 0.4; P = 0.01). Concentrations of VEGF and IL-6 were increased in all groups with RA. The overweight/obese group showed a negative correlation between the concentrations of adiponectin and VEGF (r = - 0.34; P = 0.04), a positive correlation between VEGF concentration and fat mass (r = 0.39; P = 0.02), and a negative correlation between adiponectin concentration and fat mass (r = - 0.23; P = 0.02).ConclusionInflammatory and angiogenesis activation was found in RA patients with all types of body composition, but only in those with obesity and overweight there was a direct antagonism between adiponectin and VEGF. Further research is needed to identify possible regimens of metabolic correction in different variations of body composition.
Aim of the study: Evaluation the effect of infliximab (I) on traditional indicators of activity and several cytokine, hormonal and endothelial serum biomarkers in patients with rheumatoid arthritis (RA) with different types of metabolic status. Material and Methods. 37 patients with RA (30 women and 7 men) with DAS28 index 7.2-7.4 (associated with normal body mass index-BMI, obesity and cachexia) treated with I and methotrexate were included in this study. In all patients we determined traditional markers of RA activity (DAS28, ESR, C-reactive protein) and serum biomarkerstumour necrosis factor-α (TNF-α), interleukins-6, 10 (IL-6, IL-10), adiponectin, vascular endothelial growth factor (VEGF), cortisol using enzyme linked immunosorbent assay. Results. In all patients we found high activity of RA traditional markers and high levels of TNF-α, IL-6, VEGF before I started. Low initial levels of adiponectin and high levels of cortisol we found in patients with RA associated with obesity. After 22 weeks of I course we determined decreasing of traditional RA markers and TNF-α, IL-6, VEGF in patients with normal BMI. In patients with RA and obesity we found increasing of adiponectin concentration from 2.1 (0.8-3.9) ng/ml to 5.8 (4.9-7.7) ng/ml, decreasing of high TNF-α initial level and no reduction of high IL-6 initial level. Conclusions. Thus, we have found that in general, infliximab therapy may be effective in any variants of metabolic status in patients with RA through beneficial effect with correction of most traditional and serum biomarkers. Because obese patients present a more pronounced pro-inflammatory activation and decreased adiponectin effectiveness of the biological therapy may be reduced in this group.
РЕФЕРАТ ЦЕЛЬ: ретроспективная и одномоментная оценка основных вариантов патологии почек при ревматоидном артрите (РА) с оценкой сердечно-сосудистого риска и ряда биомаркеров воспаления и дисфункции эндотелия. ПАЦИЕНТЫ И МЕТОДЫ. В ретроспективное исследование включено 780 пациентов с РА, в одномоментное-175 пациентов, у 63-выполнена нефробиопсия. Оценивали частоту различных вариантов поражения почек на фоне РА, артериальной гипертензии, анемии. Определяли сывороточные концентрации фактора некроза опухоли-α (TNF-α), интерлейкина-6 (IL-6), трансформирующего фактора роста-β1 (TGF-β1), сосудистого эндотелиального фактора роста (VЕGF). Проведено сравнение показателей в группах по уровню СКФ (более и менее 60 мл/мин). РЕЗУЛЬТАТЫ. У больных с РА показателем с наиболее выраженными статистически значимыми различиями в группах с уровнем СКФ более и менее 60 мл/мин явился 10-летний сердечно-сосудистый риск по шкале SCORЕ. Другими статистически значимыми факторами являлись: возраст, частота артериальной гипертензии, анемии, ожирение, активность биомаркеров дисфункции эндотелия. Тубулоинтерстициальный нефрит регистрировали у 27 из 63 пациентов с выполненной нефробиопсией. ЗАКЛЮЧЕНИЕ. Развитие хронической болезни почек у пациентов с РА в большей степени может быть связано с сердечно-сосудистыми факторами-индексом SCORE, прогрессирующим поражением эндотелия, возрастом, артериальной гипертензией, анемией, ожирением, а не с выраженностью провоспалительной активации. Ключевые слова: ревматоидный артрит, дисфункция эндотелия, хроническая болезнь почек, факторы роста. ABSTRACT THE AIM: retrospective and one-time evaluation of the main variants of renal pathology in rheumatoid arthritis (RA) with an assessment of cardiovascular risk and basic biomarkers of inflammation and endothelial dysfunction. PATIENTS AND METHODS. The retrospective study included 780 patients with RA, 175 patients at one time, and 63 with nephrobiopsy. The frequency of various variants of renal damage was assessed on the background of RA, arterial hypertension, anemia. Serum concentration of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), transforming growth factor β1 (TGF-β1), vascular endothelial growth factor (VEGF) were determined. The comparison of the indices in the groups by the level of GFR (more than and less than 60 ml / min) was performed. RESULTS. In patients with RA we find statistically significant differences in two groups by 10-year cardiovascular risk according to the SCORE scale was presented. Other statistically significant factors were age, the frequency of arterial hypertension, anemia, obesity, the activity of endothelial dysfunction biomarkers. Tubulointerstitial nephritis was recorded in 27 of 63 patients with nephrobiopsy performed. CONCLUSION. Chronic kidney disease in patients with RA can be associated with cardiovascular factors-SCORE index, progressive endothelial dysfunction, age, arterial hypertension, anemia, obesity, but not with the pro-inflammatory activation.
Neutrophil infiltration is implicated in the sustained thermal hyperalgesic response evoked by allergen provocation in actively sensitized rats.
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