Жесткость сосудистой стенки у пациентов с анкилозирующим спондилитом, принимающих нестероидные противовоспалительные препараты

Changes in vessel wall stiffness are a sign of endothelial dysfunction and vascular remodeling at reversible, preclinical stages and may be a marker for cardiovascular disease, including in the use of nonsteroidal anti-inflammatory drugs (NSAIDs).Objective: to study changes in vessel wall stiffness indicators in patients with active ankylosing spondylitis (AS) without cardiovascular diseases during short- and long-term therapy with NSAIDS.Patients and methods. The investigation enrolled 164 AS patients aged older than 18 years. Of them 60 patients took amtolmetin guacil (AMG) daily for 3 months within the framework of the CORONA trial, the other 104 patients received nimesulide at least thrice weekly for 60 months (the index of NSAID use was 56%) within the framework of the PROGRESS study. Vessel wall stiffness indicators (augmentation indices and aortic pulse wave velocity (PWVao)) were studied in all the patients at baseline and after 3 (for those who took AMG) and 60 (for those who received nimesulde) months.Results. At baseline, AS activity and cardiovascular risk factors were comparable in the short- and long-term follow-up groups. The mean values of aortic augmentation index (AixAo) in the patients taking AMG were 13.5% [6.08; 22.08] at baseline and 14.25% [9.4; 24.25] after 3 months of therapy (p=0.18); PWVao was 7.7 [6.72; 9.41] and 8.46 [7.28; 9.96] m/sec, respectively (p=0.007). At the same time, PWVao was >10 m/sec only in 6 (10%) patients at baseline and in 12 (20%) following 3 months. In the group of patients taking NSAIDs long, AixAo was 21.5% [11.08; 34.25] at baseline and 18.25% [09.33; 26.28] at week 12 (p=0.3); PWVao was as high as 7.6 [6.56; 7.91] at baseline and 7.8 [7.22; 8.1] m/sec at week 12 (p=0.12). The PWVao of >10 m/sec was found in 20 (19.2%) patients at baseline and in 22 (21.15%) after 60 months of follow-up and treatment. The number of patients with unidirectional changes in vessel wall stiffness indicators did not differ in the 3- and 60-month use of NSAIDs. Conclusion. During 3-month NSAID therapy, the patients with AS showed a slight increase in PWVao in the absence of changes in the other indicators of vessel wall stiffness. At the same time, the mean values of PWVao remained within the normal range and its increase >10 m/sec was detected only in 20% of the patients. Long-term NSAID therapy in AS patients without cardiovascular diseases was unaccompanied by a change in the values of vessel wall stiffness and PWVao.Изменение жесткости сосудистой стенки является признаком дисфункции эндотелия и сосудистого ремоделирования на обратимых, доклинических этапах и может быть маркером поражения сердечно-сосудистой системы, в том числе при приеме нестероидных противовоспалительных препаратов (НПВП).Цель исследования – изучение изменений показателей жесткости сосудистой стенки у пациентов с активным анкилозирующим спондилитом (АС) без сердечно-сосудистых заболеваний на фоне краткосрочной и долгосрочной терапии НПВП.Пациенты и методы. В исследование включено 164 больных АС старше 18 лет. Из них 60 пациентов в рамках исследования КОРОНА в течение 3 мес ежедневно принимали амтолметин гуацил (АМГ), остальные 104 пациента в рамках исследования ПРОГРЕСС получали нимесулид в течение 60 мес не менее 3 раз в неделю (индекс приема НПВП составил 56%). У всех больных изучали показатели жесткости сосудистой стенки (индексы аугментации и скорость пульсовой волны в аорте – PWVAo) исходно, через 3 мес (для получавших АМГ) и через 60 мес (для получавших нимесулид).Результаты. Исходно активность АС, факторы сердечно-сосудистого риска в группах краткосрочного и долгосрочного наблюдения были сопоставимы. Исходно средние значения индекса аугментации в аорте (AixAo) у пациентов, принимавших АМГ, составляли 13,5% [6,08; 22,08], через 3 мес терапии – 14,25% [9,4; 24,25] (p=0,18); PWVAo – 7,7 м/с [6,72; 9,41] и 8,46 м/с [7,28; 9,96] соответственно (p=0,007). При этом только у 6 (10%) пациентов исходно и у 12 (20%) через 3 мес PWVAo была >10 м/с. В группе больных, длительно принимавших НПВП, AixAo исходно составлял 21,5% [11,08; 34,25], на 12-й неделе – 18,25% [09,33; 26,28] (p=0,3); PWVAo исходно достигала 7,6 м/с [6,56; 7,91], на 12-й неделе –7,8 м/с [7,22; 8,1] (p=0,12). При этом исходно PWVAo >10 м/с выявлена у 20 (19,2%) пациентов, а через 60 мес наблюдения и лечения – у 22 (21,15%). Количество пациентов с однонаправленными изменениями показателей жесткости сосудистой стенки при 3- и 60-месячном приеме НПВП не различалось.Выводы. На фоне 3-месячной терапии НПВП у больных АС отмечено незначительное повышение PWVAo при отсутствии изменения других показателей жесткости сосудистой стенки. При этом среднее значение PWVAo оставалось в пределах нормы, а повышение ее >10 м/с выявлено только у 20% пациентов. При длительной терапии у больных АС, не имеющих сердечно-сосудистых заболеваний, прием НПВП не сопровождался изменением показателей жесткости сосудистой стенки и PWVAo

ИЗМЕНЕНИЕ ФУНКЦИИ ПЕЧЕНИ У БОЛЬНЫХ СПОНДИЛОАРТРИТАМИ, ДЛИТЕЛЬНО ПРИНИМАВШИХ НЕСТЕРОИДНЫЕ ПРОТИВОВОСПАЛИТЕЛЬНЫЕ ПРЕПАРАТЫ: РЕЗУЛЬТАТЫ 10-ЛЕТНЕГО ПРОСПЕКТИВНОГО ИССЛЕДОВАНИЯ ПРОГРЕСС

Objective: to assess liver function changes in patients with spondyloarthritis (SpA) taking NSAIDs regularly over a long period.Patients and methods. The data obtained during a 10-year PROGRESS prospective single-center cohort study of functional status, activity, and comorbidity (including gastrointestinal tract diseases) in patients with SpA were analyzed. The data of 363 SpA patients receiving NSAIDs regularly over a long period and followed up for 10 years were also explored. The changes that had occurred over a decade in the liver enzyme levels, the number of discontinued NSAID treatments because of a persistent increase in liver enzyme levels, and the number of prescriptions of hepatoprotective agents were analyzed.Results. For 10 years, 18 patients with SpA discontinued their NSAID intake due to elevated liver enzyme levels (≥3 times greater than the reference value); during that time, the same increase in enzyme levels was observed in 2 healthy individuals (χ2 =1.39; p=0.2). In the patients with SpA as compared to the healthy individuals, the relative risk of abnormal liver function was 1.19 (95% CI, 1.009–1.405); odds ratio was 2.9 (95% CI, 0.65–12.95). There was no increased risk for discontinuation of some NSAIDs, including nimesulide (χ2 =0.03, p=0.85), the frequency of using hepatoprotective drugs was proved to be highest for diclofenac sodium, ibuprofen, nimesulide, and ketoprofen.Conclusion. The regular long-term (as long as 10 years) use of NSAIDs to treat SpA is associated with treatment discontinuation because of elevated enzyme levels in every 10 patients. The maximum rate of discontinuation of NSAIDs due to a persistent increase in liver enzyme levels is observed 6–8 years after their regular use, so long-term NSAID therapy requires continuous monitoring of hepatic safety. The longterm intake of nimesulide, as compared with other NSAIDs, is shown to be unassociated with the higher rate of its discontinuation because of worse liver function. Hepatoprotectors are less frequently prescribed to patients taking nimesulide than to those receiving diclofenac sodium or ibuprofen and more frequently to patients using meloxicam. In most cases, prescribing hepatoprotective agents to patients receiving NSAIDs does not require discontinuation of anti-inflammatory therapy. Длительное назначение нестероидных противовоспалительных препаратов (НПВП) требует повышенного внимания к безопасности лечения, в том числе в отношении функции печени.Цель исследования – оценка изменения функции печени у больных спондилоартритами (СпА), регулярно длительно применявших НПВП.Пациенты и методы. Проведен анализ данных, полученных в ходе 10-летнего проспективного когортного одноцентрового исследования, посвященного изучению функционального статуса, активности и сопутствующей патологии (включая заболевания желудочно-кишечного тракта) у пациентов со СпА (ПРОГРЕСС). Проанализированы данные 363 больных СпА, наблюдавшихся в течение 10 лет, регулярно длительно принимавших НПВП. Анализировали произошедшие за 10 лет изменения уровня печеночных ферментов, число отмен лечения НПВП по причине стойкого повышения уровня печеночных ферментов и число назначений гепатопротекторов.Результаты. За 10 лет у 18 больных СпА из-за повышения уровня печеночных ферментов (≥3 норм) был прерван прием НПВП, за это время такое же повышение уровня ферментов отмечено у 2 здоровых лиц (χ2 =1,39, p=0,2). Относительный риск нарушения функции печени у пациентов со СпА по сравнению со здоровыми составил 1,19 (95% ДИ 1,009–1,405), отношение шансов – 2,9 (95% ДИ 0,65–12,95). Не отмечено повышения риска отмены НПВП для отдельных препаратов, включая нимесулиды (χ2 =0,03, p=0,85), частота назначения гепатопротекторов оказалась максимальной для диклофенака натрия, ибупрофена, нимесулида и кетопрофена.Выводы. Регулярный длительный (до 10 лет) прием НПВП при СпА ассоциируется с отменой лечения из-за повышения уровня печеночных ферментов у 1 из 10 больных. Максимальная частота отмен НПВП вследствие стойкого повышения уровня печеночных ферментов отмечается через 6–8 лет их регулярного приема, поэтому длительная терапия НПВП требует постоянного мониторинга печеночной безопасности. Прием препаратов нимесулида в долгосрочной перспективе не ассоциируется с большей частотой их отмен из-за ухудшения функции печени по сравнению с другими НПВП. Пациентам, принимающим нимесулид, гепатопротекторы назначаются реже, чем пациентам, получающим диклофенак натрия или ибупрофен, и чаще, чем пациентам, принимающим мелоксикам. В большинстве случаев назначение гепатопротекторов на фоне приема НПВП не требует отмены противовоспалительной терапии.

ON THE TERMINOLOGY OF SPONDYLOARTHRITIS

By the end of the first decade of the 21st century, spondyloarthritis studies have accumulated a certain number of terms that are obsolete, but used by physicians in their everyday speech, on the one hand, and a great variety of different definitions, on the other hand. In January 2014, the first organizational meeting of the Expert Group on Spondyloarthritis, Association of Rheumatologists of Russia, decided that its primary task should be to order the terminology used in this area. The authors primarily collected the terms, which had been already used in medical vocabulary, and then divided them into two categories: obsolete definitions and terms to be finalized and unified. This publication gives guidelines for using the medical terms relevant to spondyloarthritis and separately discusses how to correctly write the term sacroiliitis

Approaches to the therapy of heart failure with reduced ejection fraction. Resolution of an online meeting of the Volga Federal District experts

At an online meeting of experts held on May 14, 2021 additional research results on a sodium-glucose co-transporter-2 (SGLT2) inhibitor empagliflozin in patients with heart failure with reduced ejection fraction were considered. According to the data from the EMPEROR-Reduced international study, cardiovascular and renal effects of empagliflozin therapy in patients with and without type 2 diabetes (T2D) were analyzed. A number of proposals and recommendations was accepted regarding the further study of cardiovascular and renal effects of empagliflozin and its use in clinical practice in patients with heart failure, regardless of the T2D presence

2020 Clinical practice guidelines for Myocarditis in adults

Russian Society of Cardiology (RSC)With the participation: Eurasian Association of Therapists (EUAT), Society of Specialists in Heart Failure (OSSN), Russian Scientific Medical Society of Therapists (RNMOT), Russian Society of Pathologists, Russian Society of Radiologists and Radiologists (RSR)Endorsed by: Research and Practical Council of the Ministry of Health of the Russian Federatio

Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis: Fundamentals Of Care for UveitiS (FOCUS) Initiative

Topic: An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics. Clinical Relevance: The availability of biologic agents for the treatment of human eye disease has altered practice patterns for the management of noninfectious uveitis. Current guidelines are insufficient to assure optimal use of noncorticosteroid systemic immunomodulatory agents. Methods: An international expert steering committee comprising 9 uveitis specialists (including both ophthalmologists and rheumatologists) identified clinical questions and, together with 6 bibliographic fellows trained in uveitis, conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic review of the literature (English language studies from January 1996 through June 2016; Medline [OVID], the Central Cochrane library, EMBASE, CINAHL, SCOPUS, BIOSIS, and Web of Science). Publications included randomized controlled trials, prospective and retrospective studies with sufficient follow-up, case series with 15 cases or more, peer-reviewed articles, and hand-searched conference abstracts from key conferences. The proposed statements were circulated among 130 international uveitis experts for review. A total of 44 globally representative group members met in late 2016 to refine these guidelines using a modified Delphi technique and assigned Oxford levels of evidence. Results: In total, 10 questions were addressed resulting in 21 evidence-based guidance statements covering the following topics: when to start noncorticosteroid immunomodulatory therapy, including both biologic and nonbiologic agents; what data to collect before treatment; when to modify or withdraw treatment; how to select agents based on individual efficacy and safety profiles; and evidence in specific uveitic conditions. Shared decision-making, communication among providers and safety monitoring also were addressed as part of the recommendations. Pharmacoeconomic considerations were not addressed. Conclusions: Consensus guidelines were developed based on published literature, expert opinion, and practical experience to bridge the gap between clinical needs and medical evidence to support the treatment of patients with noninfectious uveitis with noncorticosteroid immunomodulatory agents

Базисная терапия тяжелой бронхиальной астмы у взрослых. Данные национального исследования НАБАТ

The study was aimed to Investigate severe asthma therapy in Russia. It involved 515 patients from 7 Russian cities according to the criteria of severe asthma. Individual registration cards were filled in considering dem ographic data, principal clinical features, drug therapy. It has been found that both inpatient and outpatient therapy of severe asthm a in Russia does not correspond to the standards recommended. The results confirmed high efficiency of inhaled corticosteroids when combined with long-acting β2-agonists. This therapy was found to be more effective then other regarding to symptoms, lung function param eters, rate of admission to a hospital and duration of hospital staying. Patients treated with this drug combination were satisfied by the treatment more often.Исследование проведено с целью изучения особенностей терапии тяжелой бронхиальной астмы (БА) в России. В соответствии с использовавшимися критериями тяжелой БА в исследование были включены 515 больных в 7 городах России. В каждом центре заполнялись индивидуальные регистрационные карты, при этом учитывались демографические характеристики пациента, основные аспекты клинического течения заболевания, мониторирования, фармакотерапии. Было обнаружено, что терапия тяжелой астмы в России, как на стационарном, так и на амбулаторном этапах, не соответствует рекомендованным стандартам. Результаты исследования еще раз подтверждают высокую эффективность применения комбинации ингаляционных кортикостероидов и длительнодействующих β2-агонистов. Данный вид терапии оказался эффективнее других вариантов в отношении симптомов, функции легких, частоты госпитализаций и их длительности, а пациенты, совместно получавшие ингаляционные кортикостероиды и длительнодействующие β2-агонистов были в гораздо большем количестве случаев удовлетворены лечением

Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation : Data From ROCKET AF

M. Kaste on työryhmän ROCKET AF Steering Comm jäsen.Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS(2) score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P= 75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, approximate to 7 in 10 deaths were cardiovascular, whereasPeer reviewe

Clinical features of post-COVID-19 period. Results of the international register “Dynamic analysis of comorbidities in SARS-CoV-2 survivors (AKTIV SARS-CoV-2)”. Data from 6-month follow-up

Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period

Endothelial dysfunction and dynamics of cytokine and C-reactive protein levels in chronic heart failure patients

Vasoregulatory endothelial function and dynamics of chronic inflammatory markers were investigated in patients with chronic heart failure (CHF), receiving standard therapy including ACE inhibitors, or ACE inhibitors plus aspirin. One hundred twenty CHF patients were examined at hospitalization (first 24 hours), and 20 and 90 days later, in out-patient settings. All participants were divided into two groups - with II and III functional classes of HF, by NYHA classification. In both groups, there were patients who received aspirin plus ACE inhibitors, or ACE inhibitors only. Vasoregulatory endothelial function and dynamics of chronic inflammatory marker levels were measured in all patients. Among individuals receiving ACE inhibitors, significant decrease in inflammatory marker concentrations was observed by 90 day of the follow-up, together with clinical status improvement. In ACE inhibitors plus aspirin group, no significant decrease of these parameters was registered. Vasoregulatory endothelial function did not change in both groups. Treatment with ACE inhibitors, but not ACE inhibitors and aspirin, was associated with reduction of inflammatory marker levels and clinical status improvement