Evaluation of vasomotor dysfunction with a reduction of disease activity in patients with rheumatoid arthritis: a prospective study

Introduction. Endothelial dysfunction (ED) makes a significant contribution to the pathogenesis of rheumatoid arthritis (RA). However, changes of vasomotor function (VF) in patients with a reduction in disease activity have not been studied enough. Objective – to study VF changes in patients with RA and a reduce in disease activity, to clarify the role of RA serological profile and the presence of arterial hypertension (AH) in the formation of vasomotor dysfunction.

Materials and methods. A total of 94 patients took part in the study (74 – the study group, 20 – the comparison group). The longitudinal study included 48 patients with 10 days interval between visits. RA activity reduced after prescribed anti-inflammatory therapy. All patients underwent laser Doppler flowmetry with functional tests (FT) to study VF. Also, the intensity of oxidative phosphorylation (IOP), levels of rheumatoid factor, antibodies to cyclic citrullinated peptide (ACCP) and antinuclear factor titer were assessed.

Results. Correlations of ACCP with endothelial (EС), neurogenic (NС) and cardiac (CC) components of the amplitude-frequency spectrum were revealed. With a decrease in RA activity, an increase in CC and a decrease in the total tone of resistive vessels (TTRV) were observed. There was a tendency to improve the parameters of post-occlusive hyperemia (not statistically significant). The duration and area of the reaction after acetylcholine iontophoresis increased and IOP decreased. The presence of AH reduced EС and NС, worsened post-occlusive hyperemia, and was associated with the presence of factors for RA unfavourable course.

Conclusion. The RA activity, the level of ACCP and the presence of AH make a significant contribution to the vasomotor dysfunction. At the same time, AH can be considered as a surrogate marker of an unfavourable course of RA. Endothelium-dependent regulation of blood flow, measured in FT, and IOP are closely related to disease activity. The reduce of RA activity was accompanied by a decrease in TTRV, confirming the leading role of the vasoconstriction in formation the ED pattern, the severity of ED will predominantly depend on the activity of the disease.

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