Angiopathy in rheumatoid arthritis

O.V. Syniachenko, Ye.D. Iegudina, O.O. Khanyukov, M.V. Iermolaeva

Abstract


Background. Among all rheumatologic disea­ses, rheumatoid arthritis (RA) accounts for 3 % of cases, and the number of such patients is increasing. RA is characteri­zed by systemic vascular lesion (angiopathy), it is determined by the international Chapel Hill classification as “vasculitis associated with systemic disease”. The purpose of the study was to improve the quality of diagnosis, to stablish new links in the pathogenesis and to identify the prognostic criteria for the clinical course of vascular disease in RA. Materials and methods. 131 patients were examined. The ratio of men and women was 1 : 2, the mild, moderate and high degree of the disease activity was 1 : 2 : 1, respectively, the average age of the examined patients was 45.70 ± 1.02 years, the duration of the clinical manifestation was 9.40 ± 0.68 years, I, II, III and IV stages were diagnosed in 8, 40, 34 and 19 % of patients. Echocardiography, sonography and ultrasonic dopplerography of vessels, conjunctival biomicroscopy, morphologi­cal examination of kidney biopsy were preformed, integrated indices of clinical and instrumental vascular pathology were determined. Results. Systemic angiopathy is observed in 61 % of patients with RA, more often in cases of high activity with the presence of osteoporosis, the development of skin vasculitis and peripheral vasoneuropathy are closely related to the serum levels of cyclic citrullinated peptide antibodies, which, along with the concentration of C-reactive protein, has a nega­tive prognostic significance for the vascular pathology, and the appearance of digital arteritis is determined by the activity of the joint syndrome, the appearance of glomerulonephritis — by the high content in the blood of circulating immune complexes, and angiopathy presence reflects the pressure increase in the lesser (pulmonary) circulation. Conclusions. In patients with RA, mesangial proliferative and mesangial capillary glomerulonephritis develops in a ratio of 2 : 1, with an appropriate tubulointerstitial component and the immunoglobulins and complement components deposition (in the stroma > glomeruli > tubules > vessels), at that the structural changes in the renal vessels are closely associated with clinical instrumental manifestations of systemic rheumatoid angiopathy. C-reactive protein values in the blood more than 25 mg/L and anti-citrulline antibodies more than 40 U/ml are prognostic negative criteria for systemic vascular pathology and the kidney stroma damage, severe changes in renal tubules are a risk factor for the high rates of the joint syndrome progression.

Keywords


rheumatoid arthritis; angiopathy; clinical picture; pathogenesis

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DOI: https://doi.org/10.22141/2224-1507.7.2.2017.108698

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