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ОСОБЛИВОСТІ МЕТАБОЛІЗМУ АЗОТУ У ХВОРИХ З РЕВМАТОЇДНИМ АРТРИТОМ, ПОЄДНАНИМ З АРТЕРІАЛЬНОЮ ГІПЕРТЕНЗІЄЮ ТА ЙОГО ЗМІНИ ПРИ РІЗНИХ ВИДАХ МЕДИКАМЕНТОЗНОЇ ТЕРАПІЇ

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В. С. Пехенько

Национальный медицинский университет имени А.А. Богомольца, кафедра общей практики (семейной медицины), Киев

ОСОБЕННОСТИ МЕТАБОЛИЗМА АЗОТА У БОЛЬНЫХ С РЕВМАТОИДНЫМ АРТРИТОМ, СОВМЕЩЕННЫМ С АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ И ЕЕ ИЗМЕНЕНИЯ ПРИ РАЗЛИЧНЫХ ВИДАХ МЕДИКАМЕНТОЗНОЙ ТЕРАПИИ

В работе было изучено влияние трех различных методов лечения больных с ревматоидным артритом на показатели метаболизма азота. В исследовании принимали участие 89 больных (25 чел., 64 жен., в возрасте от 35 до 65 лет) с ревматоидным артритом. Пациенты были разделены на три группы в зависимости от вида лечения, и 20 здоровых лиц. Во время исследования у пациентов, получавших терапию Ремикейдом (вторая группа) наблюдалось снижение уровня оксида азота в системном кровотоке. На фоне фармакотерапии метатрексатом (третья группа) исследуемый показатель повышался на протяжении исследования. Учитывая, что уровень суммарных метаболитов оксида азота повышался пропорционально тяжести патологического процесса - этот показатель может быть использован в качестве одного из маркеров активности процесса, тяжести течения заболевания и мониторинга лечения.

Ключевые слова: ревматоидный артрит, артериальная гипертензия, оксид азота

 

V. S. Pekhenko

National Medical University named after O.O.Bogomolets, Department of General practice (family medicine), Kyiv, Ukraine

FEATURES NITROGEN METABOLISM IN PATIENTS WITH RHEUMATOID ARTHRITIS, COMBINED WITH HYPERTENSION AND ITS CHANGES IN DIFFERENT TYPES OF MEDICATION

The the goal of our research was to explore the particularities of metabolites of nitric oxide in patients with RA combined with hypertension and their changes under the influence of treatment. 89 patients with RA and hypertension (25 male, 64 female, aged 35 to 65 years), were included in research, after obtaining informed consent. All patients, (depending on the degree of RA activity), were stratified into three groups, which were accordingly prescribed different therapeutic complexes : The first group included 32 patients (8 male, 24 female, aged 36 to 65 years) with a minimum RA activity level (as DAS 28 <3.2) who received methotrexate at a dose of 7.5 mg a week, an exacerbation glucocorticoids were administrated in initial dose of 15,0-20,0 mg with gradual reduction of 2.5 mg per week and remained at a maintenance dose of 2.5 or 5.0 mg till the end of the study; Second group consisted of 30 patients (10 male, 20 female, aged 36 to 65 years) with a third-level active RA (index DAS 28> 5.1), which had negative Mantoux test reaction, (i.e. they had no contraindictions to use "Remiсade") and who had received methotrexate at a dose of 7.5 mg a week and " Remiсade " at a dose of 3 mg/kg in/drip through infusomat at the beginning of treatment, then in two 2 weeks, again in 6 weeks, and then once in 8 weeks for 6 months; Third group was composed of 27 patients in total (7 male, 20 female, aged 35 to 64 years) who had a third-level active RA (index DAS 28> 5.1), but had contraindications to use " Remiсade " (due to positive Mantoux test) and therefore they received methotrexate from 15.0 mg (by 5.0 mg x 3) to 22.5 mg (7.5 mg x 3) a week. Because patients from 2-nd and 3-rd group had a third-level active RA, all of them also received an initial dose of glucocorticoids of 30,0-40,0 mg with further gradual reduction by 5.0 mg per week before the maintenance dose of 7,5-10, 0 mg was reached. Clinical effectiveness and safety evaluation of a therapy based on fixed combination of amlodipine and lisinopril (drug "Equator", OAO "Gideon Richter" Hungary) had demonstrated its high efficiency in the treatment of RA patients with hypertension [1]. Thus, for patients with rheumatoid arthritis in combination with hypertension was characterized by increased content of nitric oxide and its metabolites. The level of total nitric oxide metabolites increased in proportion to the severity of the pathological process. Remicade inhibits the formation of nitric oxide in the systemic circulation, which correlated with a decrease in inflammatory cytokines (second group). Against the background of pharmacotherapy methotrexate (third group) studied parameters increased during the study. In this case, the level of nitric oxide metabolites may be used as markers of a process activity, the severity of the disease and monitoring treatment.

Keywords: rheumatoid arthritis, hypertension, phagocytic cells, nitrogen oxides

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