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MITROVIC, JOSKO (2010) ARTRITE REUMATOIDE ED IPERTENSIONE ARTERIOSA: VALUTAZIONE DI ALCUNI PARAMETRI MORFO-FUNZIONALI NEL FOLLOW-UP DEI PAZIENTI. [Tesi di dottorato]

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Abstract (inglese)

BACKGROUND:There is a more visible evidence suggesting that subjects with rheumatoid arthritis (RA) have high cardiovascular morbidity and mortality as compared to the general population. This increased risk is correlated with subclinical carotid atheroslerosis and it is related mainly to chronical inflammatory process and autoimmune disregulation. The chronical inflammatory process can determinate an endothelial lesion and induce a major vascular vulnerability to cardiovascular risk factors.
OBJECTIVES: to verify possible pathogenethic mechanisms correlated to the chronical inflammatory process with an accelerated atherosclerosis in subjects with rheumatoid arthritis and primary arterial hypertension.
METHODS: 57 patients with arterial hypertension and rheumatoid arthritis compared with 47 age and sex matched controls subjects with primary hypertension and without autoimmune diseases. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum total cholesterol, HDL-cholesterol, LDL-cholesterol, tryglicerides, creatinin, glicaemia were determined in patients and controls. Rheumatoid factor (RF), anticyclic citrullinated peptide antibodies (anti-CCP), antinuclear antibodies (ANA) were determined only for the patients with RA.
CRP and the DAS 28 were used to measure systemic inflammation and disease activity, and HAQ questionnaire was used to measure the state of disability. All of the patients underwent evaluation of carotid intima-media thickness (IMT) by ultrasounds, 24-hour ambulatory blood pressure and evaluation of ambulatory arterial stifness index (AASI).
RESULTS: Common carotid IMT was significantly higher in RA patients (0.92±0.26) compared with controls (0.73±0.22), p<0.001. The systolic blood pressure (SBP) and AASI were significantly greater in the patients with RA compared with controls (SBP=137.39±18.39 vs. 130.17±13.52, p<0.05; AASI=0.47±0.16 vs. 0.39±0.17, p<0.001), and the serum HDL-cholesterol was significantly dicreased in the patients with RA compared to controls (1.45±0.35 mmol/L vs. 1.65±0.55 mmol/L, p<0.05). In RA patients common carotid IMT was significantly correlated with serum HDL-cholesterol (negative correlations r=-0.272, p<0.05), with age (r=0.549, p<0.001) and with AASI (r=0.332, p<0.05). No significant correlation was found between common carotid IMT or AASI with clinical and laboratory parameters reflecting disease activity.
CONCLUSIONS: The presence of chronic inflammatory diseases, like rheumatoid arthritis, can be considered as an additional risk factor in patients with primary arterial hypertension that can determin the major target organ demage, the accelerate atherosclerotic process and the major cardiovascular morbidity and mortality.

Abstract (italiano)

INTRODUZIONE Esistono sempre maggiori evidenze che soggetti con artrite reumatoide hanno un maggior tasso di morbidita` e mortalita` per malattie cardiovascolari. Questo aumentato rischio, legato all’aterosclerosi precoce, è strettamente correlato al processo infiammatorio cronico e alla disregolazione autoimmune. La flogosi cronica puo` determinare alterazioni parietali endoteliali, rendendo il vaso piu` suscettibile ai fattori di rischio cardio-vascolare.
SCOPO DELLA TESI e` quello di indagare alcuni possibili meccanismi patogenetici correlanti il processo iniammatorio cronico con l`accelerato sviluppo di aterosclerosi precoce nei pazienti con artrite reumatoide, affetti da ipertensione arteriosa.
PAZIENTI E METODI sono stati arruolati 57 pazienti affetti da ipertensione arteriosa essenziale con diagnosi di artrite reumatoide e 47 pazienti di controllo con diagnosi di ipertensione arteriosa ed esenti da malattie autoimmuni, combarabili per eta`e sesso. A tutti i pazienti sono stati eseguiti i seguenti esami di laboratorio: proteina C reattiva, velocità di eritrosedimentazione, assetto lipidico, creatinina, glicemia. Per i pazienti con artrite reumatoide sono stati inoltre eseguiti i seguenti esami: fattore reumatoide (FR), anticorpi antipeptide ciclico-citrullinato (anti-CCP) e anticorpi antinucleo (ANA). La proteina C reattiva e il Disease Activity Score 28 (DAS 28) furono considerati come principali indicatori di attivita` di malattia, mentre la disabilita` fu valutata mediante Health Assesment Questionnaire (HAQ).
I pazienti e i controlli furono sottoposti a valutazione dell`ispessimento dell`arteria carotide comune (IMT) mediante ultrasuonografia, al monitoraggio ambulatoriale della pressione arteriosa e alla valutazione dell`indice ambulatorio di rigidita`arteriosa (AASI).
RISULTATI: Il valore medio dell`IMT dell`arteria carotide comune e` risultato significativamente piu` elevato nei pazienti con AR (0.92±0.26) rispetto al gruppo di controllo (0.73±0.22), p<0.001. I valori della pressione arteriosa sistolica e l`indice ambulatorio di rigidita` arteriosa (AASI) sono risultati significativamente piu` alti nei pazienti con AR rispetto al gruppo di controllo (pressione sistolica=137.39±18.39 vs. 130.17±13.52, p<0.05; AASI=0.47±0.16 vs.0.39±0.17, p<0.001), inoltre i livelli sierici del colesterolo-HDL risultavano significativamente piu` bassi nei pazienti con AR rispetto ai controlli (1.45±0.35 mmol/L vs. 1.65±0.55 mmol/L, p<0.05).
Nei pazienti con AR l`IMT carotideo e` risultato significativamente correlato ai livelli sierici del colesteolol-HDL(r=-0.272, p<0.05), con l`eta`(r=0.549, p<0.001) e con l`AASI (r=0.332, p<0.05). Al contrario, nessuna correlazione significativa e` stata osservata fra l`IMT e/o l`AASI con i parametri clinico-laboratoristici di attivita` di malattia.
CONCLUSIONI La presenza di malattie croniche infiammatorie come l`artrite reumatoide può essere considerato un fattore di rischio aggiuntivo nel decorso dell'ipertensione arteriosa, capace di determinare un maggior danno d'organo, un accelerato processo aterosclerotico e quindi una maggiore morbilità e mortalità cardiovascolare.

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Tipo di EPrint:Tesi di dottorato
Relatore:OSSI, ELENA
Dottorato (corsi e scuole):Ciclo 22 > Scuole per il 22simo ciclo > SCIENZE MEDICHE, CLINICHE E SPERIMENTALI > FISIOPATOLOGIA CLINICA
Data di deposito della tesi:NON SPECIFICATO
Anno di Pubblicazione:04 Marzo 2010
Parole chiave (italiano / inglese):Artrite reumatoide, ipertensione arteriosa, patologia cardiovascolare, infiammazione, aterosclerosi sub clinica, stiffness arterioso
Settori scientifico-disciplinari MIUR:Area 06 - Scienze mediche > MED/09 Medicina interna
Struttura di riferimento:Dipartimenti > Dipartimento di Scienze Mediche e Chirurgiche
Codice ID:3031
Depositato il:30 Nov 2010 15:31
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