Farit Gabidinovich Avkhadiev (on his 70th birthday)

This article about mathematical results of F.G. Avkhadiev

EFFECT OF GOLIMUMAB ON IMMUNOLOGICAL MARKERS FOR BONE METABOLISM AND ON ARTERIAL STIFFNESS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Objective: to evaluate the effect of golimumab (GLM) on the receptor activator of NF-κB ligand (RANKL)/osteoprotegerin (OPG) transmembrane molecular system and arterial stiffness in patients with rheumatoid arthritis (RA).Subjects and methods. Thirty-six patients with RA were examined and randomized into 2 groups based on disease duration (less than or more than 2 years). The serum levels of OPG, and RANKL, were investigated. Dual-energy X-ray absorptiometry and pulse wave contour analysis were performed before and 52 weeks after GLM treatment.Results and discussion. Group 1 patients demonstrated increased serum OPG levels that were on average 3.6 times higher than in the controls (р=0.005) and 2.1 times higher than in Group 2 (р=0.01). In Group 2 patients, the RANKL concentration was 9-fold higher than that in the controls (p=0.001) and 30.6% higher than in Group 1 (p=0.01). The examinees were found to be diagnosed with subclinical damage to the great arteries (increases in augmentation index (AIp), stiffness index (SI), and reflection (RI) index), which progressed with a longer RA duration. After GLM treatment, serum OPG and RANKL levels decreased in Group 1 patients by 2.1- (p<0.001) and 1.7-fold (p<0.01), respectively. In Group 2, the level of RANKL dropped by 32.2% (p<0.01), without significant OPG concentration changes. After GLM treatment, the pulse wave contour analysis parameters in Group 1 did not differ from those in the controls; Group 2 showed significant decreases in AIp by an average of 1.8 times (p<0.01), in SI by 1.2 times (p<0.01), and in RI by 1.6 times (p<0.01).Conclusion. GLM treatment in RA patients is accompanied by a lower imbalance in the RANKL/OPG transmembrane molecular system and exerts a vasoprotective effect on the large elastic vessels (reductions in AIp and SI) and small muscular arteries (a decrease in RI)

EFFECT OF SUBCUTANEOUS METHOTREXATE ON THE STRUCTURE AND FUNCTION OF THE VASCULAR WALL IN PATIENTS WITH RHEUMATOID ARTHRITIS

Objective: to evaluate the effect of a subcutaneous methotrexate (MT) formulation (methoject), on the structure and function of the vascular wall in patients with rheumatoid arthritis (RA).Subjects and methods. A total of 94 RA patients who met the 1987 ACR or 2010 ACR/EULAR classification criteria and who were positive for IgM rheumatoid factor (RF) and/or anti-citrullinated peptide antibodies (ACPA) were examined. Carotid arteries were examined to assesslocal vascular wall stiffness, regional arterial stiffness and pulse wave velocity before and 12 months after start of MT therapy.Results and discussion. The patients with RA were found to have subclinical great artery lesion manifesting itself as increases in common carotid artery (CCA) intima-media thickness (IMT) and stiffness index and as rises in peripheral augmentation index (AIp), stiffness index (SI), and reflection index (RI), the values of which correlated with the duration of RA, DAS28, the level of RF, and the concentration of ACPA. The use of MT in the patients with RA caused a statistically significant reduction in DAS28 and a decrease in CCA intima-media complex and local vascular (carotid) stiffness. More significant changes were observed when the duration of RA was less than 2 years; by the end of the follow up, this group showed a 29% decrease in CCA IMT (p < 0.01) and an average of 22.5% reduction in CCA stiffness (p < 0.05). 12-month MT therapy decreased AIp, SI, and RI valuesto a greater extent in the patients who had RA of less than 2 years; in this patient group, these parameters reached the reference values; in late RA, there were their average decreases by 1.7 (p < 0.01), 1.3 (p < 0.01), and 1.8 (p < 0.05) times, respectively.Conclusion. MT therapy has vasoprotective activity, which is characterized by a reduction in the signs of CCA remodeling and regional stiffness in the vascular bed

EFFECT OF SUBCUTANEOUS METHOTREXATE ON THE STRUCTURE AND FUNCTION OF THE VASCULAR WALL IN PATIENTS WITH RHEUMATOID ARTHRITIS

Objective: to evaluate the effect of a subcutaneous methotrexate (MT) formulation (methoject), on the structure and function of the vascular wall in patients with rheumatoid arthritis (RA).Subjects and methods. A total of 94 RA patients who met the 1987 ACR or 2010 ACR/EULAR classification criteria and who were positive for IgM rheumatoid factor (RF) and/or anti-citrullinated peptide antibodies (ACPA) were examined. Carotid arteries were examined to assesslocal vascular wall stiffness, regional arterial stiffness and pulse wave velocity before and 12 months after start of MT therapy.Results and discussion. The patients with RA were found to have subclinical great artery lesion manifesting itself as increases in common carotid artery (CCA) intima-media thickness (IMT) and stiffness index and as rises in peripheral augmentation index (AIp), stiffness index (SI), and reflection index (RI), the values of which correlated with the duration of RA, DAS28, the level of RF, and the concentration of ACPA. The use of MT in the patients with RA caused a statistically significant reduction in DAS28 and a decrease in CCA intima-media complex and local vascular (carotid) stiffness. More significant changes were observed when the duration of RA was less than 2 years; by the end of the follow up, this group showed a 29% decrease in CCA IMT (p < 0.01) and an average of 22.5% reduction in CCA stiffness (p < 0.05). 12-month MT therapy decreased AIp, SI, and RI valuesto a greater extent in the patients who had RA of less than 2 years; in this patient group, these parameters reached the reference values; in late RA, there were their average decreases by 1.7 (p < 0.01), 1.3 (p < 0.01), and 1.8 (p < 0.05) times, respectively.Conclusion. MT therapy has vasoprotective activity, which is characterized by a reduction in the signs of CCA remodeling and regional stiffness in the vascular bed

Anatomical and ultrasound navigation of intra joint injections

Optimization of joint syndrome treatment methods, including those based on the intra- and periarticular drug administration and invasive diagnostic techniques, remains high on the agenda of modern clinical rheumatology. The implementation and quite widely spread use of ultrasonographic visualization has been an impetus to the development of this type of treatment for joint diseases. Without any doubt, the quality of intraarticular injection performance mainly depends on the professional level of the specialist and his/hers procedural skills. However, here comes a predictable question: are these conditions sufficient to enable maximal precision, safety, and efficacy of intraarticular interventions? From this perspective, it is interesting to study the possibilities to improve the results of local treatments for the joint syndrome by means of the ultrasound navigation technique. Based on data presented in the literature review, we compared a “blind” invasive treatment method to the ultrasound navigation-guided intra- and periarticular interventions in patients with skeletomuscular and connective tissue disorders. The authors of the studies published point to higher safety, efficacy, procedure precision, and diagnostic quality of the information obtained by the ultrasound navigation. Its important advantages include wider possibilities and availability of this method in outpatient settings, due to its rather low costs and patients' safety. The information from the current literature review reflects an initial stage of studies on the evaluation of the role, significance, determination of potential of the ultrasound navigation to enhance the quality of diagnosis and invasive treatment in patients with joint syndromes of various origins and to minimize adverse effects

THE EFFECT OF GOLIMUMAB ON ARTERIAL STIFFNESS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Objective: to evaluate the effect of golimumab (GLM) on arterial stiffness in patients with different clinical and immunological subtypes of rheumatoid arthritis (RA).Material and methods. Examinations were made in 48 patients with RA meeting the 1987 ACR/2010 EULAR classification criteria. The investigators visualized carotid arteries with determination of local vessel wall stiffness and studied regional arterial stiffness with assessment of contour pulse wave analysis before and 52 weeks after initiation of therapy.Results and discussion. Young and middle-aged RA patients without any concomitant cardiovascular diseases were found to have subclinical great artery involvement that was characterized by increases in intima-media thickness (IMT) and stiffness index β of the common carotid artery (CCA); by rises in peripheral augmentation index (AIp), stiffness index (SI), and reflection index (RI), the intensity of a change in which was associated with high DAS28 and seropositivity for rheumatoid factor (RF) and/or anti-cyclic citrullinated peptide (antiCCP) antibodies. GLM treatment in patients with RA was accompanied by a statistically significant decrease in DAS28 and a reduction in CCA IMT and local (carotid) stiffness of the vascular bed. More significant correction of the investigated parameters was achieved in patients with the seronegative subtype of the disease; in this group of patients, CCA IMT decreased by 29% by the end of observation (p=0.01), CCA SI β reduced by an average of 28.7% (p=0.0001). At 52 weeks after GLM therapy initiation, contour pulse wave analysis indicated that this subgroup of patients was observed to have decreases in AIp, SI, and RI to the control level; in RA seropositive for RF and/or anti-CCP, they reduced by an average of 1.8 (p=0.0001), 1.2 (p=0.005) and 1.6 (p=0.001) times, respectively.Conclusion. Along with high anti-inflammatory activity, GLM therapy in patients with RA has a vasoprotective effect on the walls of large elastic-type vessels (decreases in CCA IMT and SI β, AIp, and SI) and small muscular-type arteries (a reduction in RI)