Email this article The course of chronic heart failure in patients with early rheumatoid arthritis on the anti-rheumatic therapy
- Authors: Kirillova I.G.1, Novikova D.S.1, Popkova T.V.1, Udachkina H.V.1, Markelova E.I.1, Gorbunova Y.N.1, Korsakova Y.O.1
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Affiliations:
- V.A. Nasonova Research Institute of Rheumatology, Russian Academy of Medical Sciences
- Issue: Vol 47, No 5 (2019)
- Pages: 400-409
- Section: ARTICLES
- URL: https://almclinmed.ru/jour/article/view/1146
- DOI: https://doi.org/10.18786/2072-0505-2019-47-056
- ID: 1146
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Abstract
Objective: To evaluate the effect of the “treat to target” anti-rheumatic therapy on the course of chronic heart failure (CHF) in patients with early rheumatoid arthritis (RA).
Materials and methods: The study included 22 patients (17, or 77% female) with CHF with valid diagnosis of RA (ACR/EULAR criteria, 2010), median (Me) age of 60 years, and median disease duration of 7 months. Ten patients (45%) were seropositive for IgM rheumatoid factor and 22 (100%) had antibodies to cyclic citrulline peptide. Their median (1st; 3rd quartiles) DAS28 was 5.6 [4.8; 6.5]. The diagnosis of CHF was confirmed in accordance with the guidelines on the diagnosis and treatment of CHF by the Russian Society of Specialists in Heart Failure (2013). NT-proBNP levels were measured by electrochemiluminescence (Elecsys proBNP II, Roche Diagnostics, Switzerland). All patients were started on subcutaneous methotrexate (MT) with rapid dose titration to 30 mg weekly. If the MT was insufficiently effective, a biological disease-modifying antirheumatic drug (bDMARD) was added to the therapy after 3 months, mainly a TNF-alpha inhibitor. After 18 months, 10 (45%) patients were in remission and had low disease activity, 6 (60%) patients underwent MT therapy in combination with bDMARDs.
Results: At baseline, 21 (95%) patients were diagnosed with CHF with preserved ejection fraction and one patient had CHF with reduced ejection fraction. After 18 months there was an improvement of clinical symptoms, echocardiographic parameters (reduction of the left atrium diameter and the left atrium end-systolic volume index, IVRT, E'LV), and diastolic function of the left ventricle (LV). No episodes of acute CHF deterioration were registered. LV diastolic function normalized in 7 (32%) patients who reached the target level of blood pressure, remission (n=5) and low disease activity (n=2), mainly under the treatment with MT and bDMARDs. In patients with RA and CHF, the NT-proBNP levels decreased from 192.2 [151.4; 266.4] to 114.0 [90.4; 163.4] pg/ml (p<0.001) and became normal in 16 of 22 (73%) patients (p<0.001) with remission or low RA activity. In 5 (22%) patients, clinical CHF manifestations resolved, LV diastolic function and NT-proBNP levels were normalized.
Conclusion: In the patients with early RA and CHF anti-rheumatic therapy improves the clinical course of CHF, LV diastolic function and reduces NT-proBNP levels.
Keywords
About the authors
I. G. Kirillova
V.A. Nasonova Research Institute of Rheumatology, Russian Academy of Medical Sciences
Author for correspondence.
Email: dr.i.kirillova@yandex.ru
ORCID iD: 0000-0002-1003-2087
Irina G. Kirillova – MD, Research Fellow, Systemic Rheumatic Diseases Laboratory
34A Kashirskoe shosse, Moscow, 115522
Russian FederationD. S. Novikova
V.A. Nasonova Research Institute of Rheumatology, Russian Academy of Medical Sciences
Email: fake@neicon.ru
ORCID iD: 0000-0003-0840-1549
Diana S. Novikova – MD, PhD, Leading Research Fellow, Systemic Rheumatic Diseases Laboratory
34A Kashirskoe shosse, Moscow, 115522
Russian FederationT. V. Popkova
V.A. Nasonova Research Institute of Rheumatology, Russian Academy of Medical Sciences
Email: fake@neicon.ru
ORCID iD: 0000-0001-5793-4689
Tatiana V. Popkova – MD, PhD, Head of Systemic Rheumatic Diseases Laboratory
34A Kashirskoe shosse, Moscow, 115522
Russian FederationH. V. Udachkina
V.A. Nasonova Research Institute of Rheumatology, Russian Academy of Medical Sciences
Email: fake@neicon.ru
ORCID iD: 0000-0002-3661-6427
Helen V. Udachkina – MD, Research Fellow, Systemic Rheumatic Diseases Laboratory
34A Kashirskoe shosse, Moscow, 115522
Russian FederationE. I. Markelova
V.A. Nasonova Research Institute of Rheumatology, Russian Academy of Medical Sciences
Email: fake@neicon.ru
ORCID iD: 0000-0002-1729-4610
Evgenia I. Markelova – MD, Senior Research Fellow, Systemic Rheumatic Diseases Laboratory
34A Kashirskoe shosse, Moscow, 115522
Russian FederationYu. N. Gorbunova
V.A. Nasonova Research Institute of Rheumatology, Russian Academy of Medical Sciences
Email: fake@neicon.ru
ORCID iD: 0000-0002-2024-6927
Yulia N. Gorbunova – MD, Research Fellow, Systemic Rheumatic Diseases Laboratory
34A Kashirskoe shosse, Moscow, 115522
Russian FederationYu. O. Korsakova
V.A. Nasonova Research Institute of Rheumatology, Russian Academy of Medical Sciences
Email: fake@neicon.ru
ORCID iD: 0000-0002-3052-7466
Yulia O. Korsakova – MD, Physician, Laboratory of Instrumental and Ultrasonic Diagnostics
34A Kashirskoe shosse, Moscow, 115522
Russian FederationReferences
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