Риск развития сердечно-сосудистых событий у больных ревматоидным артритом (РА) выше, чем в популяции в 3,96 раза. Одним из модифицируемых факторов риска является артериальная гипертензия (АГ). Согласно данным литературы у 10-30% больных АГ является «маскированной», т.е. выявляется только при суточном мониторировании артериального давления (АД). По данным собственного исследования распространенность «маскированной» АГ среди больных РА составляет 28,2%. В группе больных с сочетанием АГ и РА 7,5% пациентов имели резистентную АГ, 36,8% больных регулярно не контролировали уровень АД. При суточном мониторировании жесткости артерий, по нашим данным, у больных РА в сочетании с АГ амбулаторный индекс ригидности достоверно выше, чем у больных эссенциальной АГ (p<0,05). Известно, что базисные противовоспалительные препараты снижают сердечно-сосудистый риск, однако данные в отношении симптоматической терапии нестероидными противовоспалительными препаратами (НПВП) и глюкокортикоидами не однозначны. Гипотензивная терапия больных АГ в сочетании с РА должна подбираться с учетом проводимой противовоспалительной терапии. Наиболее оправдано назначение блокаторов кальциевых каналов, которые не снижают свою эффективность при одновременном назначении с НПВП. Ключевые слова: ревматоидный артрит, артериальная гипертензия, суточное мониторирование артериального давления и жесткости артерий.

Background Even the earliest subclinical renal dysfunction is an important independent risk factor for cardiovascular disease [1]. It is cardiovascular complications associated with atherosclerotic vascular disease that are the leading causes of premature mortality in rheumatoid arthritis (RA) [2]. Objectives To determine the urinary excretions of albumin in patients with RA, to identify the relationship of this indicator with risk factors for cardiovascular disease. Methods The study included 73 patients with RA at the age 18 to 60 years, who were treated at the rheumatology department of the regional hospital. Exclusion criteria were an associated kidney diseases, hypertension stage III, any kind of secondary nephropathy and pregnancy. We investigated the urinary excretions of albumin (Al) by immunoturbidimetric method in a morning urine sample. The urinary albumin excretion was considered normal for the index of Al/urine creatinine less than 17 mg/g in men and 25 mg/g in women. The arterial stiffness was detected using a Tensioclinic arteriograph (Tensiomed, Hungary). The pulse wave velocity in the aortaand augmentation index were measured. The ultrasound measuring of the carotid intima-media thickness was performed to study subclinical atherosclerosis. Results The urinary excretion of Al in the patients with RA was significantly higher than in control subjects matched for age, body mass index, blood pressure (50.27 [23.2, 100.82] mg/g and 23.43 [17.92, 30.42] mg/g, respectively, p<0.001). Increased urinary albumin excretion was found in 52 (71%) patients. The correlation was found of the urinary excretion of Al with age (r = 0.266; p = 0.023), the multiplicity of nonsteroid anti-inflammatory drugs (NSAIDs) in the month prior to the study (r = 0.271; p = 0.027), glomerular filtration rate, which was calculated by using the Modification of Diet in Renal Disease (r = -0.282; p = 0.016), low density lipoprotein (r= 0.367; p = 0.005), atherogenic index (r = 0.415; p = 0.001), pulse wave velocity in the aorta (r = 0.258; p = 0.039), augmentation index in the aorta and brachial artery (r = 0.346; p = 0.005), the carotid intima-media thickness (r = 0.270; p = 0.021). Conclusions The urinary excretion of Al in the patients with RA is significantly higher than in the control group. Increased urinary albumin excretion correlates with risk factors for cardiovascular disease (hypertension, dyslipidemia, the arterial stiffness) and with the features of the development of the RA (multiple NSAIDs). References Astor B.C., Hallan S.I.Miller E.R. et al. Glomerular filtration rate, albuminuria, and risk of cardiovascular and all-cause mortality in the US population. American Journal of Epidemiology2008;167:1226-1233 CaplanM. J. Cardiovasculardiseaseinrheumatoidarthritis. Curr. Opin. Rheumatol., 2006;18:289-97. Disclosure of Interest None Declared

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Background The leading causes of premature mortality in rheumatoid arthritis (RA) are cardiovascular complications [1]. Even the earliest subclinical renal dysfunction is an important independent risk factor for cardiovascular disease [2]. One of the methods of early diagnosis of renal disease can be the assessment of tubular damage. Objectives To examine of the urinary excretionsof the markers of tubular dysfunction in patients with rheumatoid arthritis. Methods The study included 73 patients with RA at the age 18 to 60 years, who were treated at the rheumatology department of Saratov Regional Hospital. Exclusion criteria were an associated kidney diseases, hypertension stage III, any kind of secondary nephropathy and pregnancy. We investigated the urinary excretionsof α1-microglobulin (α1-Mg) and albumin (Al) by immunoturbidimetric method and urine enzymes (gamma glutamattranspeptidase (GGT) and lactatedehydrogenase (LDH)) by the kinetic method in a morning urine sample. The content of α1-Mg and Al was recalculated per 1 g of creatinine, GGT and LDH - per 1mmol urine creatinine. Results In patients with RA compared with a control group matched for age, sex, body mass index, blood pressure, increased urinary excretionofα1-Mg (26.6 [18.69, 37.57] mg / g and 13.75 [10.91, 18.69] mg / g, respectively, p <0.001), GGT (2.59 [1.26, 5.12] U / mmol, and 1.89 [1.22, 2.65] U / mmol, p = 0.045) and LDH (3.14 [1.47, 5.92] and 1.93 [0.82, 3.31], respectively, p = 0.008) was detected. Even in patients with normal urinary albumin excretion (<25 mg / g for women and 17 mg / g in men, n = 21) urinary excretionofα1-Mg was higher than in controls (18.69 [11.93, 19.9] mg/g and 12,85 [9,52; 18,69], p = 0.037). Correlation was found out of α1-Mg level with the duration of morning stiffness (r = 0.354; p = 0.002), the multiplicity of nonsteroid anti-inflammatory drugs (NSAIDs) in the month prior to the survey (r = 0.318; p = 0.009), duration of NSAID history (r = 0.270; p = 0.021), the dose of methotrexate at the time of examination (r = -0.452; p = 0.004), the indices HAQ (r = 0.447; p = 0.004) and PAS (r = 0.450; p = 0.004), triglycerides (r = 0.247; p = 0.048), in patients older than 40 years - with radiologic stage of RA (r = 0.407; p = 0.005). GGT level correlates with systolic (r = 0.338; p = 0.006) and diastolic (r = 0.301; p = 0.023) blood pressure at the time of the survey, the concentration of triglycerides (r = 0.374; p = 0.019), the index scale SCORE (r=0.222; p=0.048); LDH level correlates with the multiplicity of NSAIDs in the month prior to the survey (r = 0.374; p=0.004), the index scale SCORE (r=0.252; p=0.031), concentration of low-density lipoprotein (r=0.366; p=0.006). Conclusions The urinary excretion of markers of tubulointerstitial dysfunction in patients with RA is higher than in healthy individuals. The most sensitive marker of tubulointerstitial dysfunction is α1-Mg. The severity of tubular damage correlates with the presence and degree of hypertension and dyslipidemia, the index scale SCORE, the multipli...