Background:Similarities in risk factors, initial stages, progression and final stage of both atherosclerotic cardiovascular disease (ACVD) and chronic kidney disease (CKD) allowed formulating a concept of cardiorenal continuum.1ACVD and CKD remain the main causes of mortality in rheumatoid arthritis (RA) patients.2,3Objectives:To evaluate the effects of rituximab (RTM) therapy on cardiorenal continuum of RA patients.Methods:Biologics-naïve RA patients (n=92; age 49.5±9.9) were followed up for 72 months after commencing and continuing RTM therapy (1–10 standard courses) compared with 50 control RA patients (age 49.2±9.8). All control and 63% of RTM patients received methotrexate or leflunomide.Results:There were no baseline differences between two groups – Table. At year 6, RTM patients have fewer incidences of hypertension, anxiety/depression, atherosclerosis and diastolic dysfunction than controls. RTM decreased prevalence of albuminuria and CKD.Table.Cardiorenal continuum of rheumatoid arthritis patients (%)FeaturesRituximab groupControl grouppRTM–C1 year n=923 years n=476 years n=311 yearn=503 years n=266 years n=16Risk factorsHypertension52.238.325.8p6–1=0.02250.038.550.0p6=0.032Dyslipidaemia44.636.238.748.046.250.0>0.05Pre-diabetes41.336.241.944.034.656.3>0.05Metabolic syndrome12.06.43.210.07.712.5>0.05Diabetes mellitus3.2002.000>0.05Anxiety/depression78.341.5p3–1=0.00535.3p6–1<0.00176.073.168.8p3=0.009p6=0.008Initial stages (asymptomatic organ damage)Atherosclerosis34.821.312.9p6–1=0.04536.034.637.5p6=0.02Left ventricular hypertrophy8.74.308.07.70>0.05Diastolic dysfunction57.638.322.6p6–1=0.01856.050.056.3p6=0.04Albuminuria19.600p6–1=0.03812.006.3>0.05Kidney impairment6.52.106.000>0.05ProgressionAngina6.5004.000>0.05Chronic kidney disease26.18.59.7p6–1=0.04212.000>0.05End stageMyocardial infarction000000>0.05Stroke000000>0.05Heart failure4.400000>0.05Acute/chronic renal failure000000>0.05Death000000>0.05There were no significant differences in frequencies of other risk factors, signs of organ damage and cases of established heart, cerebrovascular and renal diseases/complications.Conclusion:RTM may be effective in delay of the movement of RA patients on cardiorenal continuum. The clinical implications of RTM for cardiorenal correlations in RA patients need to be confirmed in large-scale clinical outcome trials.References:[1]Sarnak MJ, Levey AS. Cardiovascular disease and chronic renal disease: a new paradigm.Am J Kidney Dis2000;35(4, Suppl. 1):117–31.[2]Avina-Zubieta JA, Choi HK, Sadatsafarvi M,et al.Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies.Arthritis Rheum2008;59:1690–7.[3]Gullick NJ, Scott DL. Co-morbidities in established rheumatoid arthritis.Best Pract Res Clin Rheumatol2011;25:469–83.Disclosure of Interests:Ilshat Gaisin Speakers bureau: Boehringer Ingelheim, KRKA, Berlin-Chemie Menarini, Sanofi, Larisa Ivanova Speakers bureau: Bayer, Novartis, KRKA, Nikolay Maximov Speakers bureau: Pfizer, KRKA, Rosa Valeeva: None declared, Dilara Yurk: None declared, Anastasia Vedekhina: None declared, Nuriya Garaeva: None declared, Irina Sabelnikova: None declared

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Сердечно-сосудистые заболевания (ССЗ) у беременных женщин -один из самых клинически значимых видов хронической экстрагенитальной патологии и одна из главных причин материнской и перинатальной смертности в мире [1][2][3]. Болезни сердца и сосудов встречаются у 10-32 % беременных, и их частота неуклонно возрастает [3,4]. Летальность беременных, рожениц и родильниц от ССЗ составляет 0,2-2,5% [1], а удельный вес этой причины материнской смертности (МС) в развитых странах остается высоким (до 15-20%) и продолжает расти [5,6]. В недавнем прошлом из об-щего числа женщин, умерших от экстрагенитальных заболеваний, по причине различных ССЗ погибали 22-33,4% [1]. В настоящее время вопрос сохранения и ведения беременности у женщин со сложной кардиальной патологией все чаще становится актуальным предметом клинических обсуждений. Существенно расширились показания для возможности вынашивания беременности у женщин, которым ранее не разрешалось иметь детей [3,7]. Все это происходит благодаря значительному прогрессу в диагностике, своевременному оперативному лечению подобных боль-Система оказания кардиологической помощи беременным женщинам в Удмуртской Республике И.Р. Гайсин*, Р.М. Валеева, Л.В. Шилина, Н.Ю. Чернышева, Н.И. Максимов Кафедра госпитальной терапии Ижевской государственной медицинской академии, Республиканский клинико-диагностический центр, 426009 Ижевск, ул. Ленина, 87 Цель. Оценить эффективность специализированной помощи беременным женщинам с сердечно-сосудистыми заболеваниями (ССЗ) в Удмуртской Республике (УР). Материал и методы. Проведено проспективное и ретроспективное исследование исходов беременности у всех 17 948 женщин, находившихся в период с 2000 по 2007 год на лечении в созданной в УР системе оказания помощи беременным с ССЗ. Система включает специализированные женскую консультацию, стационарное отделение и родильный дом при региональном кардиологическом центре. Наблюдались беременные с артериальной гипертонией, врожденными и ревматическими пороками сердца, сердечными аритмиями, некоронарогенными заболеваниями миокарда, мезенхимальными дисплазиями, аутоиммунными болезнями соединительной ткани и др.

Background:Raynaud’s phenomenon (RP) secondary to rheumatic diseases (RD) can progress to irreversible tissue damage with digital ulceration, scarring and, rarely, gangrene requiring amputation1. Current medical treatments for RP are far from ideal: they are often either ineffective and/or poorly tolerated, thus a significant proportion of patients discontinue drug therapy2.Objectives:To determine RP expression levels and to evaluate the long-term efficacy of iloprost and alprostadil in RP patients with RD.Methods:Indicated therapy with intravenous iloprost (n=10), alprostadil (n=17) or their combinations (n=13) was carried out for three years in patients with secondary RP in RD. Frequency of Raynaud’s attacks, digital ulcers (DU) formation and pain intensity on visual analogue scale (VAS) were evaluated. A control group included 30 patients with RP in RD who did not receive prostanoid therapy. By factor analysis method a generalized index of RP expression was identified, on the basis of which levels of RP expression were determined.Results:“RP expression” scale, revealed as an indicator of RP generalized manifestation, was an average value of two subscales: (1) consisted of 4 indices “DU”, “digital pitting scars”, “phalange amputation” and “frequency of Raynaud’s attack”, (2) included 3 indicators: “intensity of pain”, “duration of illness”, “whitening of fingers”. Correlation of subscales showed their reliability (r=0.294, p=0.053). RP final expression (severity) was 1.51±0.86. A low level of RP expression had values below 0.65, a high level – over 2.37. At baseline, the high level of RP severity was defined in 16 (22.9%) patients, medium – in 43 (61.4%), low – in 11 (15.7%).RP treatment with iloprost was effective in the healing of DU in 100% of patients and led to decrease of RP expression generalized index from 2.25 [1; 3] to 1.75 [1; 2] (p=0.012). Alprostadil therapy reduced pain intensity on VAS (p<0.05) and numbness during Raynaud’s attacks (p<0.01) and decreased RP expression from 1 [1; 2] to 1 [0.5; 1.5] (p=0.038). Patients on prostanoids combination had new DU and amputations; pain intensity reduced by 47% (p<0.05), RP expression generalized indicator did not change.Conclusion:Based on RP clinical manifestations in RD patients, a generalized index of RP expression was identified and levels of RP severity were determined. Treatment with iloprost or alprostadil has significant effects on reducing the clinical manifestations of RP with a corresponding decrease in its severity. Iloprost is indicated in patients with medium and high levels of RP expression index, alprostadil – with medium and low index and non-effectiveness of calcium channel blockers.References:[1]Hughes M, Herrick AL. Digital ulcers in systemic sclerosis.Rheumatology (Oxford) 2017;56 (1):14–25.[2]Kowal-Bielecka O, Fransen J, Avouac J et al. Update of EULAR recommendation for the treatment of systemic sclerosis.Ann Rheum Dis2017;76(8):1327–39.Acknowledgments:Professor LP. Anan’evaDisclosure of Interests:Ilshat Gaisin Speakers bureau: Boehringer Ingelheim, KRKA, Berlin-Chemie Menarini, Sanofi, Zukhra Bagautdinova: None declared, Marianna Glavatskikh: None declared, Nikolay Maximov Speakers bureau: Pfizer, KRKA, Rosa Valeeva: None declared, Oxana Desinova: None declared, Rushana Shayakhmetova: None declared

Background Both hypertension (HT) and pre-eclampsia (PE) have been recognized as an important cause of chronic kidney disease (CKD) in women. There are no uniform recommendations for the treatment of HT with kidney damage after PE yet. Methods In a case-control, open-label 1-year study, 54 post-partum women (aged 25–37 years) with grade 2 (53.7%) or 3 (46.3%) HT and kidney damage [48 patients (88.9%) had moderately increased albuminuria (30–299 mg/g), 6 (11.1%) – severely increased albuminuria (&gt;300 mg/g), 32 (59.3%) – mildly decreased eGFR (60–89 mL/min/1.73 m2 (BSA)) and 3 (5,6%) – mildly to moderately decreased eGFR (45–59 mL/min/1.73 m2)] after early-onset PE (with delivery at &lt;34+0 weeks of gestation) superimposed to HT received either adjusted-dose ACE inhibitors – ACEi (33 non-feeding mothers: 19 – perindopril, 5 – ramipril, 9 – perindopril and indapamide SR combination) or methyldopa (21 nursing women). No significant differences observed between two groups at baseline. Results After comprehensive follow-up, blood pressure (BP) was not found to differ between ACEi and methyldopa groups (123.2±2.4/78.5±1.5 mmHg vs. 136.2±4.8/86.2±3.2 mmHg respectively, p&gt;0.05) with more strict BP control on ACEi. There were significant differences in albuminuria reduction, in favour of ACEi (–207.2 mg/24 h vs. –33.7 mg/24 h, p&lt;0.01) and in eGFR increasing (+19.4 mL/min/1.73 m2 (BSA) vs. +6.6 mL/min/1.73 m2 (BSA), p=0.029), as well as in decrease of left ventricular (LV) mass index (−31.2 g/m2 vs. −16.7 g/m2, p=0.038) and increase of LV ejection fraction (+8.2% vs. +1.9%, p=0.022). Treatment with ACEi more improved endothelial function, non-invasively assessed by flow-mediated dilatation of a brachial artery using high-resolution ultrasound (+10% vs. +3.4%, p=0.035) and decreased intima media thickness (−0.33 mm vs. −0.17 mm, p=0.009). In a year, all methyldopa patients had albuminuria, C1 stage of CKD was in 13 (61.9%) women, CKD C2 in 8 (38.1%). In ACEi group, CKD C1 had 7 (21.2%) mothers (p&lt;0.01), C2 – none (p&lt;0.01). Conclusion Non-feeding women with grade 2 or 3 post-partum HT and renal damage after early-onset PE get greater heart, kidney and vessels benefits from 1-year ACEi treatment than nursing mothers from methyldopa. Funding Acknowledgement Type of funding source: None