Dynamic of changes in coronary artery calcification in early rheumatoid arthritis patients over 18 months.

The coronary artery calcification (CAC) progression may be useful noninvasive predictor of future cardiovascular events (CVE). The progression rate of CAC in patients with early rheumatoid arthritis (RA) is poorly understood. To assess the dynamic of CAC scores in early RA patients for 18 months, 74 RA adult patients (ACR/EULAR criteria, 2010, duration ≤ 12 months, with moderate/high RA activity, without prior administration of disease-modifying anti-rheumatic drugs or glucocorticoids) were enrolled within the framework of the observational study: women 73%, median age 56 years, median RA duration 6 months, median DAS28[ESR] 5.4. Most of the patients had multiple Traditional Risk Factors (TRFs) of Cardiovascular Disease (CVD). All patients at baseline and after 18 months underwent 32-row scanning for CAC scoring. In patients younger than 45 years (n = 16) any CAC was not detected during 18 months. Among patients older than 45 years four new events of CAC were detected. Among patients older than 45 years with baseline CAC (n = 34) increase in CAC scores was detected in 82% cases. Among them, Δ Agatston Score exceeded the median annual Agatston Score progression predicted for the general population according to the Multi-Ethnic Study of Atherosclerosis (MESA) data in 57% of early RA patients. The significant increase of Agatston Score in accordance with Sevrukov's method was met in one patient with newly diagnosed CAC and among patients with baseline CAC-in 29%. The presence of CAC progression was associated with lower baseline total cholesterol (TC) level (p < 0.05). The extent of CAC progression associated with male gender and arterial hypertension (AH) (p < 0.05). Association between CAC dynamic and statin therapy, RA activity and cumulative inflammatory burden, response to anti-rheumatic therapy and the type of this therapy were not detected. Early RA patients older than 45 years have high incidence of CAC progression during 18 months. More than half of the early RA patients had the increase in AS which exceeded the median annual progression of Agatston Score in the MESA. The CAC progression was associated with male gender, AH and lower baseline TC level. We did not detect any association between CAC progression and statin therapy, RA activity and type of anti-rheumatic therapy.

Calcification of coronary arteries in early rheumatoid arthritis prior to anti-rheumatic therapy.

Accelerated coronary atherosclerosis is common in patients with rheumatoid arthritis (RA). To examine coronary artery calcification (CAC) frequency and severity, its correlation with traditional risk factors (TRF) of cardiovascular diseases (CVD) and inflammatory markers in patients with early RA prior to anti-rheumatic therapy. RA adult patients (ACR/EULAR criteria, 2010, duration ≤ 12 months, without prior administration of disease-modifying anti-rheumatic drugs, glucocorticoids) underwent 32-row scanning for CAC scoring. Agatston, volume and mass calcium scores were calculated. Additionally, we used calculators on the website of the Multi-Ethnic Study of Atherosclerosis. 74 RA patients (women n = 54 (73%), median age 56 years, median RA duration 6 months) with moderate/high RA activity (median DAS28 [ESR] 5.4) were enrolled within the framework of the observational study. Most of the patients had multiple TRFs of CVD and subclinical organ damage. CAC has been detected in 34 (46%) early RA patients. Calcification severity was significantly higher in men and in patients with ischemic heart disease (IHD). In patients younger than 45 years (n = 16) CAC was not detected. Among patients older than 45 years (n = 58), the frequency of CAC was 59%: asymptomatic patients-n = 46 (48%), IHD patients-n = 12 (100%). Among asymptomatic patients the presence of CAC associated with a significantly higher frequency of arterial hypertension (1.6 fold) compared with cases without CAC. Coronary age in asymptomatic patients with CAC and IHD patients was significantly greater than their actual age. More than half of early RA patients older 45 years had CAC. The presence and severity of CAC correlated positively with TRFs, but not with lipid levels and RA activity.

Determination of Heterogeneous Proteomic and Metabolomic Response in anti-TNF and anti-IL-6 Treatment of Patients with Rheumatoid Arthritis.

Reduction in tumor necrosis factor (αTNF) and interleukin-6 (IL-6) activities is a widely utilized strategy for the treatment of rheumatoid arthritis (RA) with a high success rate. Despite both schemes targeting the deprivation of inflammatory reactions caused by the excessive activity of cytokines, their mechanisms of action and the final output are still unequal. This was a comparative longitudinal study that lasted for 24 weeks and aimed to find the answer to why the two schemes of therapy can pass out of proportion in attitude of their efficiency. What are the differences in metabolic and proteomic responses among patients who were being treated by either the anti-TNF or anti-IL-6 strategy? We found increased levels of immunoglobulins A and G (more than 2-fold in anti-IL-6 and more than 4-5-fold in anti-TNF groups) at the final stage (24 weeks) of monitoring but the most profound increase was determined for µ-chains of immunoglobulins in both groups of study. Metabolomic changes displayed main alterations with regard to arginine metabolism and collagen maintenance, where arginine increased 8.86-fold (p < 0.001) in anti-TNF and 5.71-fold (p < 0.05) in anti-IL-6 groups but patients treated by the anti-TNF scheme suffered a higher depletion of arginine before the start of therapy. Some indicators of matrix and bone tissue degradation also increased 4-hydroxyproline (4-HP) more than 6-fold (p < 0.001) in anti-TNF and more than 2-fold (p < 0.05) in the anti-IL-6 group, but the growth dynamics in the anti-IL6 group was delayed (gradually raised at week 24) compared to the anti-TNF group (raised at week 12) following a smooth reduction. The ELISA analysis of IL-6 and TNFα concentration in the study population supported proteomic and metabolomic data. A positive correlation between ΔCDAI and ΔDAS28 indicators and ESR and CRP was established for the majority of patients after 24 weeks of treatment where ESR and CRP reduced by 20% and 40% finally, respectively. A regression model using the Forest Plot was estimated to elucidate the impact of the most significant clinical, biochemical, and anthropometric indicators for the evaluation of differences between considered anti-TNF and anti-IL-6 schemes of therapy.