rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2018-328-332rsp-2567Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHВлияние противоревматической терапии на уровень N-терминального натрийуретического пептида у больных ранним ревматоидным артритомIMPACT OF ANTIRHEUMATIC THERAPY ON THE LEVEL OF N-TERMINAL PRO-BRAIN NATRIURETIC PEPTIDE IN PATIENTS WITH EARLY RHEUMATOID ARTHRITISКирилловаИ. Г.KirillovaI. G.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow; 115522

dr.i.kirillova@yandex.ruНовиковаД. С.NovikovaD. S.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow; 115522

ПопковаТ. В.PopkovaT. V.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow; 115522

УдачкинаЕ. В.UdachkinaE. V.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow; 115522

МаркеловаЕ. И.MarkelovaE. I.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow; 115522

НовиковА. А.NovikovA. A.

129090, Москва, ул. Щепкина, 35

35, Shchepkin St., Moscow 129090

ГорбуноваЮ. Н.GorbunovaYu. N.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow; 115522

ВолковА. В.VolkovA. V.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow; 115522

ЛучихинаЕ. Л.LuchikhinaE. L.

129110, Москва, ул. Щепкина 61/2, к. 1

61/2, Shchepkin St., Build. 1, Moscow 129110

ДемидоваН. В.DemidovaN. V.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow; 115522

БорисоваМ. А.BorisovaM. A.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow; 115522

ЛукинаГ. В.LukinaG. V.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow; 115522

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian FederationЕвропейский медицинский центр (ЕМС)РоссияEuropean Medical Center (EMC)Russian FederationГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского»РоссияM.F. Vladimirsky Moscow Regional Research Clinical InstituteRussian Federation201815072018563328332Copyright © Кириллова И.Г., Новикова Д.С., Попкова Т.В., Удачкина Е.В., Маркелова Е.И., Новиков А.А., Горбунова Ю.Н., Волков А.В., Лучихина Е.Л., Демидова Н.В., Борисова М.А., Лукина Г.В., 20182018Кириллова И.Г., Новикова Д.С., Попкова Т.В., Удачкина Е.В., Маркелова Е.И., Новиков А.А., Горбунова Ю.Н., Волков А.В., Лучихина Е.Л., Демидова Н.В., Борисова М.А., Лукина Г.В.Kirillova I.G., Novikova D.S., Popkova T.V., Udachkina E.V., Markelova E.I., Novikov A.A., Gorbunova Y.N., Volkov A.V., Luchikhina E.L., Demidova N.V., Borisova M.A., Lukina G.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/2567

Цель исследования – изучить влияние противоревматической терапии, проводимой в соответствии с принципом лечения до достижения цели («treat-to-target», T2T) на динамику уровня NT-proBNP у пациентов с ранним ревматоидным артритом (РА) в течение 18-месячного периода наблюдения.

Материал и методы

Материал и методы. В исследование включено 74 пациента с достоверным диагнозом РА (критерии ACR/EULAR 2010 г.), в том числе 56 женщин (74%), медиана возраста – 54 года, длительности заболевания – 7 мес; серопозитивных по IgM ревматоидному фактору (87%) и/или антителам к циклическому цитруллинированному пептиду (100%), не получавших ранее базисные противовоспалительные препараты (БПВП) и глюкокортикоиды. Всем пациентам начата терапия метотрексатом (МТ) с эскалацией дозы до 25–30 мг/нед подкожно, при отсутствии эффекта МТ через 3 мес 47 больным (71%) присоединяли генноинженерные биологические препараты (ГИБП). Через 18 мес 44% больных достигли ремиссии РА; 51 пациент (77%) получал кардиопротективную терапию. Оценка уровня NT-proBNP проведена у 66 пациентов с ранним РА до начала терапии и после 18 мес лечения. За норму принят уровень NT-proBNP <125 пг/мл.

Результаты и обсуждение

Результаты и обсуждение. На фоне противоревматической терапии отмечалось снижение медианы уровня NT-proBNP со 125 [65; 208] до 68 [33; 115] пг/мл (р<0,05) и частоты его повышенных значений с 49 до 21% (р<0,02). У больных с ремиссией РА зарегистрировано более выраженное уменьшение частоты повышенных значений NT-proBNP (с 45 до 7%; р<0,05), тогда как у пациентов, не достигших ремиссии РА, отмечалась лишь тенденция к снижению (с 51 до 32%; р<0,05). У больных, достигших ремиссии РА на фоне лечения, отмечалась нормализация уровня NT-proBNP. Не наблюдалось прогрессирования существующей и развития новых случаев хронической сердечной недостаточности (ХСН).

Заключение

Заключение. Зарегистрировано значимое снижение уровня NT-proBNP на фоне противоревматической терапии, проводимой согласно стратегии Т2Т, особенно при использовании комбинации МТ+ГИБП и достижении ремиссии РА. Терапия МТ и ГИБП не приводила к ухудшению течения или развитию новых случаев ХСН у больных ранним РА. 

Objective

Objective: to investigate the impact of antirheumatic therapy carried out according to the treat-to-target (T2T) principle on the time course of changes in NT-proBNP levels in patients with early rheumatoid arthritis (RA) over an 18- month follow-up period.

Subjects and methods

Subjects and methods. The investigation enrolled 74 patients, comprising 56 (74%) women (median age, 54 years) with a reliable diagnosis of RA (ACR/AULAR criteria (2010)) (disease duration, 7 months); who were seropositive for IgM rheumatoid factor (87%) and/or anti-cyclic citrullinated peptide antibodies (100%) and had not previously taken disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids. All the patients started therapy with subcutaneous methotrexate (MTX), with escalation of the dose to 25-30 mg/week; in the absence of any effect after 3 months, biological agents (BAs) were added in 47 (71%) patients. Following 18 months, 44% of patients achieved RA remission; 51 patients (77%) received cardioprotective therapy. NT-proBNP levels were measured in 66 patients with early RA before and 18 months after treatment. The NT-proBNP value <125 pg/ml was taken to be normal.

Results and discussion

Results and discussion. During antirheumatic therapy, there was a decrease in the median level of NT-proBNP from 125 [65; 208] to 68 [33; 115] pg/ml (p < 0.05) and in the frequency of its elevated values from 49 to 21% (p < 0.02). In the patients with RA remission, there was a more pronounced decrease in the frequency of elevated NT-proBNP values (from 45 to 7%; p < 0.05), while in those who had not achieved RA remission, NT-proBNP values showed only a tendency to decrease (from 51 to 32%; p < 0.05). The level of NT-proBNP became normal in the patients who had achieved remission of RA during treatment. There was no progression of the existing chronic heart failure (CHF) or development of its new cases.

Conclusion

Conclusion. A significant decrease in NT-proBNP levels was recorded during antirheumatic therapy performed according to the T2T strategy, especially when using a combination of MTX+BAs and achieving RA remission. Therapy with MTX and BAs did not lead to the worsening of CHF or to the development of its new cases in patients with early RA. 

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The authors declare that there are no conflicts of interest present.