EFFECT OF RITUXIMAB ON THE BLOOD CHOLESTEROL TRANSPORT SYSTEM IN PATIENTSWITH RHEUMATOID ARTHRITIS

Objective: To study the time course of changes in the indices of the blood lipid spectrum in patients with rheumatoid arthritis (RA) treated
with rituximab during a 24-week follow-up.
Subjects and methods. The study enrolled 39 patients (36 females and 3 males) with a valid diagnosis of RA; their mean age was 50 years;
disease duration 93.5 months; duration activity scale (DAS) 6.1 scores. A previous ineffective treatment with methotrexate was found in 6
patients; that with two basic anti-inflammatory drugs or more in 30, and previous TNF-ƒ inhibitor therapy failed in 14 of the 39 patients.
The blood lipid spectrum and intima-media thickness (IMT) were determined before and 24 weeks after the first injection of rituximab.
The drug was intravenously administered dropwise in a dose of 1000 mg twice at a 14-week interval. Therapeutic efficiency was estimated
according to the RA activity index - DAS28. All the patients showed a satisfactory/good response to rituximab therapy.
Results. There was a double reduction in the frequency of hypoalfalipoproteinemia and in the increased atherogenicity index (AI). Elevated
cholesterol (CH), triglycerides (TG), and low-density lipoprotein (LDL CH) levels were found in equal frequencies before and 24 week
after rituximab administration. There was a 5% rise in CH concentrations, a considerable (22%) increase in high-density lipoprotein CH,
and an 18.6% decrease in AI (p<0.05 in all cases). The levels of LDL CH and TG tended to increase; however, they failed to achieve statistical
significance. The change in the spectrum of lipids and blood lipoproteins was associated with the pronounced decline in disease
activity (decreases in C-reactive protein concentrations, erythrocyte sedimentation rate, IgM rheumatoid factor, and DAS28 index) and
better patient functional status (Health Assessment Questionnaire (HAQ) index) (p<0.05). There was a significant reduction in the maximum
carotid IMT in patients with RA: it was 1.09 (0.94-1.2) and 0.95 (0.8-1.3) mm before and 24 weeks after rituximab administration,
respectively (p=0.001).

rheumatoid arthritis, chronic inflammation, blood lipid spectrum, rituximab

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