microcirculationРегионарное кровообращение и микроциркуляцияRegional blood circulation and microcirculation1682-66552712-9756Academician I.P. Pavlov First St. Petersburg State Medical University10.24884/1682-6655-2025-24-3-13-25microcirculation-1447Research ArticleОБЗОРЫREVIEWSВлияние терапии ингибиторами фактора некроза опухоли альфа и ингибиторами интерлейкина-6 на эндотелиальную дисфункцию у пациентов с ревматоидным артритомEffect of Tumor Necrosis Factor Alpha Inhibitor and Interleukin-6 Inhibitor Therapy on Endothelial Dysfunction in Patients with Rheumatoid Arthritishttps://orcid.org/0000-0002-9404-712XКононыхинА. А.KononykhinA. A.

Кононыхин Алексей Андреевич – аспирант

640014, г. Курган, ул. Марии Ульяновой, д. 6

Kononykhin Aleksey A. – Postgraduate Student

6, Maria Ulyanova street, Kurgan, 640014

kononykhin.al98@mail.ruФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр травматологии и ортопедии имени академика Г. А. Илизарова» Министерства здравоохранения Российской ФедерацииРоссияIlizarov National Medical Research Center for Traumatology and OrthopedicsRussian Federation2025261020252431325Copyright © Кононыхин А.А., 20252025Кононыхин А.А.Kononykhin A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.microcirc.ru/jour/article/view/1447

Ревматоидный артрит (РА) представляет собой хроническое аутоиммунное заболевание, характеризующееся поражением суставов и внутренних органов. Внедрение в клиническую практику терапии генно-инженерными биологическими препаратами (ГИБП) позволило существенно улучшить качество жизни пациентов с РА, уменьшить частоту развития инвалидизирующих изменений в суставах, а также обеспечить хороший контроль над активностью заболевания. Вместе с тем проблема ускоренного развития атеросклероза и повышенного сердечно-сосудистого риска при РА не теряет своей актуальности. Существенный вклад в прогрессирование атеросклероза у пациентов с РА вносят эндотелиальная дисфункция (ЭД) и системное воспаление. В настоящем обзоре проанализирована роль интерлейкина-6 (ИЛ-6) и фактора некроза опухоли альфа (ФНО-а) в патогенезе атеросклероза и ЭД, представлены современные научные данные о влиянии ГИБП на функцию эндотелия у пациентов с РА, а также рассмотрены лабораторные маркеры и инструментальные методы исследования дисфункции эндотелия. Белок программируемой клеточной смерти 1 (programmed cell death 1, PD-1), ИЛ-18, ИЛ-10, гранулоцитарно-макрофагальный колониестимулирующий фактор (GM-CSF), а также фракталкин являются перспективными терапевтическими мишенями в терапии РА и атеросклероза. При планировании и организации клинических исследований новых лекарственных препаратов, предназначенных для лечения РА, оправданным является включение дополнительных конечных точек, посвященных оценке развития и прогрессирования атеросклероза и ЭД. По данным экспериментальных и клинических исследований терапия ГИБП способствует уменьшению выраженности ЭД, что положительно сказывается на состоянии сосудистой стенки, приводит к замедлению прогрессирования атеросклеротического поражения артерий и снижению сердечно-сосудистой смертности у пациентов с РА. В этой связи является целесообразным рассмотрение вопроса о возможном включении атеросклероза в число показаний для инициации терапии ГИБП у пациентов с РА.

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by damage to joints and internal organs. The introduction of biologic disease-modifying antirheumatic drugs (bDMARDs) into clinical practice has significantly improved the quality of life of patients with RA, reduced the incidence of disabling changes in the joints, and provided good control over disease activity. At the same time, the problem of accelerated atherosclerosis and increased cardiovascular risk in RA remains relevant. Endothelial dysfunction (ED) and systemic inflammation make a significant contribution to the progression of atherosclerosis in patients with RA. This review analyzes the role of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-a) in the pathogenesis of atherosclerosis and ED, presents current scientific data on the effect of bDMARDs on endothelial function in patients with RA, and also considers laboratory markers and instrumental methods for studying ED. Programmed cell death protein 1 (PD-1), IL-18, IL-10, granulocyte-macrophage colony-stimulating factor (GM-CSF), and fractalin are promising therapeutic targets in the treatment of RA and atherosclerosis. When planning and organizing clinical trials of new drugs intended for the treatment of RA, it is justified to include additional endpoints devoted to assessing the development and progression of atherosclerosis and ED. According to experimental and clinical studies, therapy with bDMARDs helps to reduce the severity of ED, which has a positive effect on the condition of the vascular wall, slows the progression of atherosclerotic lesions of the arteries and reduces cardiovascular mortality in patients with RA. In this regard, it is appropriate to consider the possible inclusion of atherosclerosis in the indications for initiating therapy with bDMARDs in patients with RA.

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The authors declare that there are no conflicts of interest present.