Early signs of myocardial dysfunction in patients with rheumatoid arthritis and ankylosing spondylitis

The objective of the study – identify early preclinical signs of myocardial dysfunction in patients with rheumatoid arthritis and ankylosing spondylitis.Material and methods. We examined 142 people with verified rheumatic diseases. All patients were divided into 2 groups. The first group consisted of patients with rheumatoid arthritis – 95 people. The second group – patients with ankylosing spondylitis – 47 people. The control group included 70 practically healthy individuals. In addition to standard diagnostic tests, all patients underwent tissue dopplerography of the heart using the GE Vivid E9 ultrasound device using the two-dimensional deformation technique (speckle tracking) to assess the deformation and rate of myocardial deformation, as well as determining the level of matrix metalloproteinase-9 in the blood serum.Results. Among patients with rheumatoid arthritis, diastolic dysfunction of both the left ventricle and both ventricles was more common than in the control group. The same pattern was observed in the group with ankylosing spondylitis. The calculation of the relative risk showed that the presence of rheumatoid arthritis in 4,42 times increases the risk of diastolic dysfunction of the left ventricle in comparison with practically healthy people (CI 1,6–12,2). In individuals with rheumatoid arthritis also results in a deterioration of systolic function of both ventricles. The level of matrix metalloproteinase metalloproteinase-9 was highest and most often increased in patients with ankylosing spondylitis. Among patients with rheumatoid arthritis, the average level of metalloproteinase-9 was low, but the incidence was higher than in the control group. The obtained results indicate that in these rheumatic diseases there is a marked degradation of the extracellular matrix components.Conclusion. Patients with rheumatoid arthritis and ankylosing spondylitis are characterized by a deterioration in the diastolic function of the left ventricle or both ventricles simultaneously, which is accompanied by an increase in the level of metalloproteinase-9

EFFECT OF RITUXIMAB ON CARDIAC ELECTROPHYSIOLOGICAL PARAMETERS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Rheumatoid arthritis (RA) is an autoimmune rheumatic disease characterized by damage not only to the joints, but also to the viscera, including the heart. The cardiovascular risk in patients with RA is 1.5 times higher than that in the general population. In this connection, the treatment should be aimed not only at joint diseases, but should also prevent fatal heart failure. Rituximab (RTM) is a biological drug that has proven to be highly effective in treating different diseases, including RA.Objective: to investigate the effect of RTM on cardiac electrophysiological parameters in patients with RA.Subjects and methods. Examinations were made in 83 patients with seropositive RA, of whom 21 patients received RTM at a dose of 1000 mg according to the scheme for 6–12 months and oral methotrexate at a dose of up to 25 mg weekly (Group 1) and 62 took oral methotrexate at a dose of up to 25 mg weekly for at least 12 months (Group 2). In addition to standard diagnostic methods, the investigators performed electrocardiography to calculate Q–T dispersion and vectorcardiography to determine the loop areas of P, QRS and T, as well as MV vector, MV azimuth, MV elevation.Results and discussion. In Group 1, Q–T dispersion was lower than that in Group 2 (p<0.05). There was also a correlation between ESR and T loop area (r=0.633; p<0.05).Conclusion. When RTM is used, ventricular myocardial repolarization disorders that are a marker of cardiac electrophysiological remodeling and are related to the activity of the disease are less pronounced