FEATURES OF THE COURSE OF RHEUMATOID ARTHRITIS IN PATIENTS WITH NON-ALCOHOLIC STEATOHEPATITIS.
DOI:
https://doi.org/10.11603/2415-8798.2017.1.7286Keywords:
rheumatoid arthritis, non-alcoholic steatohepatitis, hepatic elastography, liver stiffness, methotrexate, corticosteroids.Abstract
More and more attention of researchers recently is focused on to identify concomitant liver disease in patients with rheumatoid arthritis. Therefore, the search for new pathogenetic approaches to the problem of the relationship between morpho-functional state of the liver and over of RA is a topical issue that requires a detailed study, determining the indications for additional screening and optimization of the treatment process.
The aim of the study – studying of morpho-functional state of the liver, the detection rate of nonalcoholic steatohepatitis and to assess the clinical and laboratory characteristics of flow and programs for the treatment of RA depending on the existence of liver disease.
Materials and Methods. For the analysis of the intensity of pain we used visual analogue pain scale (VAS) to characterize the activity of RA we used scale of disease activity DAS28. Patients underwent laboratory tests, including biochemical analysis of blood with the aim of studying the functional state of the liver was determined by alanine aminotransferase (ALT), aspartate aminotransferase (AST), г-glutamyl transferase (GGT), alkaline phosphatase (ALP), bilirubin, total protein. Assessment of the titer of antibodies to cyclic citrullinated peptides was carried out by ELISA method. To visualize changes of the hepatic parenchyma in all patients were performed ultrasound examination with B-mode elastography simultaneously by the method of SWEI.
Results and Discussion. We found that the presence of the non-alcoholic steatohepatitis (NASH) in patients with RA was associated with increased duration of disease and high degree of inflammatory activity. Among this group of patients predominated patients with the presence of positive аnti-CCP . The structure of associated states showed a high percentage of patients with metabolic syndrome, a combination of hypertension and diabetes among cohorts under the joint RA and NASH. Also, we found that among the patients with NASH the significant majority of patients who are constantly receiving corticosteroids and methotrexate in doses of 15 mg per week.
Conclusions. An increase in the frequency of comorbidities (hypertension, type 2 diabetes, obesity) and expression and severity of clinical symptoms of RA (intensity of pain (VAS mm), the presence of antibodies to cyclic citrullinated peptides, increase the degree of activity) was observed in patients under the combination of NASH and RA. At the same time it was noted that the most patients of this group regularly had used glucocorticosteroids (GCS) and dose methotrexate more than 15 mg per week.
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