ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 17 of 67
JMBS 2020, 5(4): 138–144
Clinical Medicine

Features of Endothelial Function and Cytokin Profile in Patients with Rheumatoid Arthritis in Combination with Arterial Hypertension

Daniuk I. O. 1, Ryndina N. G. 2

The international study COMORA found out that hypertension was one of the most common comorbid disease in patients with rheumatoid arthritis. The combination of rheumatoid arthritis and hypertension is associated with an unfavorable prognosis and earlier development of cardiovascular complications. The purpose of the study was to study the vasomotor and secretory function of the endothelium in patients with moderate rheumatoid arthritis activity in combination with stage II hypertension and to establish a link between cytokines imbalance and endothelial dysfunction. Material and methods. The main group of patients included 93 patients with rheumatoid arthritis of moderate activity in combination with stage II hypertension. The second group had 45 patients with essential hypertension stage II. The control group included 31 almost healthy people. Results and discussion. We detected the endothelium-dependent vasodilation in the rheographic modification of the sample with reactive hyperemia on the brachial artery, the concentration of asymmetric dimethylarginine, the final stable metabolites of nitric oxide, interleukin-1 beta (IL-1β), interleukin-10 (IL-10) and highly sensitive C-reactive protein in blood serum. We determined the significant decrease of endothelium-dependent vasodilation in patients with rheumatoid arthritis in combination with hypertension 7.58 [3.68; 11.59] % compared to the group of patients with essential hypertension 10.28 [7.69; 14.02] % and to the control 25.23 [20.63; 27.83] %. There was a significant decrease of nitric oxide total metabolites 15.0 [12.5; 18.0] μmol/L in comparison to the group of patients with essential hypertension – 17.0 [15.0; 20.0] μmol/L and to the control group – 2.0 [22.0; 24.0] μmol/L. The level of total nitric oxide metabolites in a subgroup of patients with rheumatoid arthritis with hypertension of the 2nd grade was 12.15 [11.0; 13.0] μmol/L, which was on 28,63 % lower compared to the subgroup with 1st grade hypertension – 17.0 [14.0; 19.0] μmol/l (p <0.001). We found a significant increase of asymmetric dimethylarginine 0.78 [0.68; 0.88] μmol/L in patients with rheumatoid arthritis with hypertension compared to the patients with essential hypertension – 0.61 [0.58; 0.64] μmol/L and to the group of control – 0.53 [0.50; 0.59] μmol/L. The concentration of asymmetric dimethylarginine in the subgroup of patients with rheumatoid arthritis and hypertension grade 2 was 0.98 [0.882; 1.213] μmol/l, which was on 27.2 % higher than in subgroup of patients with hypertension of 1st degree – 0.71 [0.661; 0.778] μmol/l (p <0.001). We found the correlations between markers of nitric oxide and asymmetric dimethylarginine (R = -0.82, p <0.01), endothelium-dependent vasodilation and asymmetric dimethylarginine (R = - 0.79, p <0.01) in patients of the main group. The study results showed that a significant increase of IL-1β in patients of the main group 16.25 [7.67; 21.66] pg/ml in compared to the second group – 4.13 [2.98; 5.18] pg/ml and to the control – 2.79 [2.14; 3.13]. We determined correlations between asymmetric dimethylarginine and IL-1β (R = + 0.81, p <0.001), ratio of IL-β / IL-10 (R = + 0.59, p <0.001) and highly sensitive C-reactive protein (R = + 0.80, p <0.001) in patients of the main group. Conclusion. The level of total nitric oxide metabolites had correlations with indicators of IL-1β (R = - 0.71, p <0.001), ratio of IL-1β / IL-10 (R = - 0.70, p <0.001) and highly sensitive C-reactive protein (R = - 0.65, p <0.001) in the main group. We established the correlations between highly sensitive C-reactive protein level and endothelium-dependent vasodilation (R =- 0.69, p <0.001), highly sensitive C-reactive protein and asymmetric dimethylarginine (R = + 0.80, p <0.001) in patients of the main group.

Keywords: rheumatoid arthritis, hypertension, endothelial dysfunction

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