Dyslipidemia and Nonalcoholic Fatty Liver Disease in Rheumatoid Arthritis Patients

Abstract

Liver damage in patients with immunoinflammatory rheumatic diseases is one of the urgent problems of modern medicine. Mostly, nonalcoholic fatty liver disease (NAFLD) is developed in patients with rheumatoid arthritis (RA) with high clinical and immunological activity of the disease. Despite the presence of a large number of studies devoted to the problem of the development of dyslipidemia and liver steatosis in RA, information about their mechanisms and prevalence of risk factors remains controversial and requires further research. The objective: to analyze the state of lipid metabolism in patients with RA in combination with NAFLD and without signs of liver damage. Materials and methods. 156 persons who were divided into two groups took part in the study. The main group included 126 patients with RA, the control group – 30 persons without autoimmune pathology. To determine the parameters of lipid metabolism, the participants underwent a blood laboratory test to study the parameters of the lipidogram. An ultrasound examination (USE) of the liver was performed for study the state of the hepatobiliary system. Results. Based on the results of liver USE, it was found that the majority of patients with RA have an increased liver size and liver fatty infiltration (steatosis) of various degrees of severity. I degree steatosis was determined in 30 (38.96%) patients with RA, II degree – in 28 (36.36%) and III degree – in 19 (24.67%) RA patients. As for the control group, steatosis I degree was diagnosed in only 1 (3.33%) person, II degree – 1 (3.33%) individual. The results of the lipidogram study showed that patients with RA and steatosis have elevated serum triglycerides. An increased total cholesterol was found in patients with RA and NAFLD. Analysis of low-density lipoprotein (HDL) cholesterol levels showed that RA and NAFLD patients had HDL levels 18.00% lower compared to controls and 21.01% lower compared to RA patients without NAFLD. An increased LDL in patients with RA and NAFLD indicates the risk of development of atherosclerosis and cardiovascular diseases in this group of people. Conclusions. In 77 (61.10%) examined RA patients, liver steatosis of various degrees was detected by ultrasound examination. The combination of RA with NAFLD is associated with more pronounced proatherogenic dyslipidemias compared to patients with RA without NAFLD. Hepatic steatosis is associated with a significant increase in TG and LDL cholesterol levels and an increased atherogenicity. A standard clinical and laboratory and instrumental examination of patients with RA should include an assessment of the state of the liver (ultrasound examination, laboratory parameters) and lipid metabolism for further application of therapeutic and preventive non-medicinal and medicinal algorithms for the correction of detected disorders.