1

Abstract

Background. It is known that the hemostasis system, inflammation and innate immunity have a common evolutionary origin, which explains the pathogenetic aspects of the relationship between inflammation and disorders in the hemostasis system. When the immune response is disturbed (autoimmune diseases), the inflammation becomes chronic. Unlike thrombosis associated with injury, the inflammatory process can initiate thrombosis in an intact vessel. Therefore, the purpose of this study was to assess the state of the hemostasis system in children with juvenile idiopathic arthritis in the dynamics of observation. Materials and methods. Eighty-five children aged 8–18 years with juvenile ­idiopathic arthritis were exa­mined in the dynamics of observation. The immunological activity of the disease, coagulogram parameters, functional state of the kidneys, blood lipids were studied. Statistical processing of the material was performed using Statgraphics 16.0 Centurion. Results. Analysis of the coagulogram in the group as a whole showed an increase in the level of D-dimer in the dynamics of observation (p < 0.03) against the background of constant use of basic therapy. As inflammation is the main connecting factor for atherosclerosis and thrombosis, the parameters of the hemostasis system were analyzed in the group with high total cholesterol. It was found that in the presence of atherogenic changes in the blood lipids, there were also signs of increased clot formation. The parameters of the coagulogram were studied in the group of patients with signs of kidney damage. A pro­bable increase in prothrombin time (p < 0.05) and a significant level of D-dimer in both the first and second studies were detected indicating a tendency to thrombosis in these children. According to some authors, methotrexate, which is most often used in the treatment of rheumatoid arthritis, leads to a significant reduction in the incidence of atherosclerosis and the total number of cardiovascular diseases. It was found that on the background of methotrexate therapy, there was an increase in the prothrombin index and the preservation of high le­vels of D-dimer. Treatment with tumor necrosis factor α inhibitors helps reduce the level of autoimmune inflammation. It was found that only in children who received combination therapy with methotrexate and tumor necrosis factor α blocker adali­mumab, there was a probable decrease in the level of the main factor in thrombus formation, D-dimer (p < 0.05). Conclusions. In children with juvenile idiopathic arthritis, with the long-term course of the disease, there are early preclinical signs of thrombus formation. Monotherapy with methotrexate helps reduce autoimmune inflammation, but only the inclusion in the treatment measures of biologically active compounds prevents the further development of such life-threatening conditions as athero- and venous thrombosis.