Научно-практическая ревматология (Jul 2016)

TIME COURSE OF STRUCTURAL AND FUNCTIONAL CHANGES IN THE MYOCARDIAL ARTERIES OF PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH METHOTREXATE AND HYDROXYCHLOROQUINE DURING A 4-YEAR FOLLOW-UP PERIOD

  • A. V. Petrov,
  • A. A. Zayaeva,
  • N. V. Matveeva

DOI
https://doi.org/10.14412/1995-4484-2016-299-303
Journal volume & issue
Vol. 54, no. 3
pp. 299 – 303

Abstract

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Many patients with rheumatoid arthritis (RA) develop myocardial damage that is frequently latent and usually manifests itself as congestive heart failure and arrhythmias in the late period of the disease.Objective: to comparatively study the time course of clinical, structural, and functional changes in the myocardium in RA patients taking methotrexate (MTX) and a combination of MTX and hydroxychloroquine (HC) during a 4-year follow-up period.Subjects and methods. Clinical data and echocardiographic, carotid artery ultrasonographic, and Holter electrocardiogram (ECG) monitoring readings were analyzed in 83 patients with RA with disease duration of < 10 years, who had received MTX (n = 44) or a combination of MTX and HC (n = 39) for 4 years. RA activity remained low (DAS28 ≤ 3.1) during the follow-up period.Results and discussion. Over 4 years, the RA patients showed significant increases in left ventricular mass index (from 106.20 [98.14; 112.44] to 114.23 [109.12; 131.19]), in the rate of eccentric left ventricular hypertrophy (from 22.9 to 40.9%), frequent supraventricular extrasystoles (from 13.3 to 22.8%), different types of premature ventricular contractions (from 14.2 to 26.2%), paroxysmal ventricular tachycardia (from 1.2 to 3.6%), intraventricular conduction disturbances (from 3.6 to 14.4%), and first-degree atrioventricular block (from 2.4 to 4.8%), as well as atherosclerotic plaques in the carotid arteries (from 6.0 to 10.8%) (p < 0.05). During combined therapy with MTX and HC, the increase in the rate of eccentric left ventricular hypertrophy, high-grade premature ventricular contractions, and right bundle-branch block was not so great as that during MTX monotherapy (5.1 and 29.6%; 5.1 and 18.2%; 2.6 and 11.4%, respectively).Conclusion. There is evidence that HC intake has a positive impact on myocardial structural and functional parameters in RA patients.

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