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Kamilova Umida Kabirovna, Doctor of Science, professor, Deputy Director for Research of the State Institution "Republican Specialized Scientific and Practical Medical Center of Therapy and Medical Rehabilitation", Tashkent, Uzbekistan Saidova Muhabbat Mukhiddinovna, Basic doctoral of Bukhara State Medical Institute E-mail: kamolaxon.abrorovna@gmail.com
PREDICTION OF PROGRESSION OF CARDIOVASCULAR DISEASE IN PATIENTS WITH RHEUMATOID ARTHRITIS
Abstract. The objective of this paper was to predict the development of cardiovascular diseases in patients with rheumatoid arthritis. Conducted study of the common cardiovascular diseases risk factors revealed that in patients with rheumatoid arthritis arterial hypertension was the most common in 98 (62.4%) patients examined. Coincidently, the occurrence of such risk factors as arterial hypertension, hypercholesterolemia and obesity depends on age: in patients aged 50-60, the occurrence of arterial hypertension was 4.4 times more often, hypercholesterolemia was 4.8 times, and obesity was 2.4 times more when compared to the group of patients aged 35-49 years. In patients with rheumatoid arthritis, the determination of total cardiovascular risk on the mSCORE chart has important prognostic significance.
Keywords: rheumatoid arthritis, cardiovascular disease, risk factors, prediction, prognosis.
Rheumatoid arthritis (RA) is a widespread autoimmune disease of unknown etiology characterized by symmetrical erosive synovitis, destruction of cartilage and bone tissues, and also often by a broad spectrum of systemic symptoms. In most cases, the disease has a chronicity, which may lead (in the absence of timely and adequate therapy) to progressive destruction, deformity and dysfunction of the joints, a significant reduction in the quality of life and premature death. RA. is known for a high risk of cardiovascular complications (CVC) [1; 2]. It is important for fundamental applied medicine to study of the immunopathogenesis of cardiovascular diseases (CVD), the specifics of their diagnosis and treatment in RA. Aforementioned requires an interdisciplinary approach to managing patients, with the participation of rheumatolo-gists, cardiologists and therapists. To solve this problem, it is necessary to evaluate the morbidity of CVD, cardiovascular risk factors and metabolic disorders; to group patients predisposed to the development of CVC; to study the effect of antirheumatic drugs on the cardiovascular system; to develop a complex of preventive and therapeutic measures aimed at reducing the risk of CVC; to create a system of dynamic control and monitoring of the cardiovascular pathology development in this category of patients [3; 4]. An array of scientific data, obtained as a result of large multicenter studies, suggests that the immune-inflammatory cascade in systemic connective tissue diseases (SCTD) contributes to the progression of the atherosclerotic processes [5]. These patients have a high level of cardiovascular morbidity. Evaluation of traditional risk factors
for cardiovascular diseases (CVD) does not reflect the true prognosis of these patients [6]. The cause of premature death in half of the deceased patients with rheumatological diseases is the pathology of the cardiovascular system associated with atherosclerosis (AS) of blood vessels, and not with inflammatory damage to the structures of the heart. One of the main causes of mortality in RA is cardiovascular accidents (myocardial infarction (MI), stroke, and sudden cardiac death), due to the early development and rapid progression of atherosclerotic vascular lesions [7]. Recent studies have shown that an increase in the risk of cardiovascular complications (CVC) in RA is associated not only with traditional risk factors (RF), but also with immune-inflammatory mechanisms underlying the pathogenesis of RA and atherosclerosis [8]. Arterial hypertension (AH) is the most important modifiable risk factor for the development of cardiovascular diseases (CVD). The presence of hypertension in RA patients is associated with an increase in subclinical manifestations of the carotid arteries atherosclerosis and is one of the main independent predictors of CVC [9; 10].
Objective. Prognosis of cardiovascular disease development in patients with rheumatoid arthritis.
Materials and methods
157 patients with RA aged from 35 to 60 years old (mean age is 51.6 ± 0.5) were examined. RA was diagnosed using ACR (1987) and ACR/EULAR (2010) classification criteria. 129 (82%) of examined patients were women and 28 (18%) were men. 113 (72%) of the patients had seropositive RA and
Section 2. Medical science
44 (28%) had seronegative RA. 51 of the examined were aged 35-49 years old and 106-50-60 years old.
Results
Analysis of the results has shown that most common risk factor was arterial hypertension present in 98 (62.4%) of the examined patients. Hypercholesterolemia was detected in 35 (22.3%) and obesity in 54 (34.4%) patients. Considering that 82% of the surveyed women, such RFs as smoking occurred in 10.8% of cases. Coincidently the occurrence of such RF as AH, HCS and obesity depends on age: in patients aged 50-60, the occurrence of AH was 4.4 times more often, HCS was 4.8 times, and obesity was 2.4 times more when compared to the group of patients aged 35-49 years. Comorbidity with diseases such as coronary heart disease and diabetes mellitus is also more common in patients aged 50-60 years.
We used the SCORE risk chart to predict the risk of cardiovascular diseases, which classifies patients according to age, gender, total cholesterol, systolic blood pressure (SBP),
Table 1.- Cardiovas
and smoking/non-smoking using low and high risk matrices. Cross-checking data for each patient generates a cell containing a number representing the numerical value of the SCORE risk chart, and a color representing the 10-year risk of fatal cardiovascular complications of each patient. The SCORE risk chart should not be used for patients in the high and very high cardiovascular risk category. To calculate the cardiovascular risk in patients with rheumatoid arthritis (RARA), the mSCORE risk chart was used, which compiles the results of the SCORE risk chart multiplied by 1.5. Based on calculations of SCORE and mSCORE, patients with a 10-year risk of fatal cardiovascular complications less than 1% were stratified as "low risk", from > 1 to 5% as "moderate", from > 5% up to 10% as "high risk", > 10% as "very high risk".Among the examined 157 patients with RA. were 6 patients with coronary artery disease and 9 diabetes mellitus who were excluded from the study to predict cardiovascular complications, the SCORE and mSCORE charts were used for 146 patients (Table 1).
ar events prognosis
Total patients 146 SCORE mSCORE
Low < 1% 45(30.8%) 45(30.8%)
Moderate < 5% 84(57.5%) 81(55.5%)
High < 10% 12(8.2%) 8(5.5%)
Very high > 10% 5(3.2%) 12(8.2%)
The results of mSCORE analysis showed that patients with RA had a low risk of cardiovascular disease in 45 (30.8%) patients, moderate in 81 (55.5%), high in 8 (5.5%) and very high in 12 (8.2%). When comparing the results of the SCORE and mSCORE risk charts, the very high risk by the mSCORE chart is 8.2%, which is 2.5 times more than by the SCORE chart. Cardiovascular risk by mSCORE among patients aged 50-60 years was more common than in patients aged 35-49 years. Predicting the development of CVDs and their prevention is a set of coordinated activities aimed at the entire population or certain groups of the population to prevent the
development and progression of CVDs or minimize the burden of CVDs and related disability [11; 12]. In this regard, the use of the mSCORE chart in patients with will help predict the development of cardiovascular events, assess the risk and develop preventive measures.
Conclusion
In summary, the early detection of cardiovascular diseases risk factors in patients with rheumatoid arthritis and the cardiovascular events prognosis will help prevent the development and progression of cardiovascular diseases.
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