Avaliação das adipocitocinas pré e pós tratamento com tocilizumabe em pacientes com artrite reumatoide

• Autor(a) principal: Freitas, Ana Beatriz Santos Bacchiega de
• Data de Publicação: 2015
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/8659
• topic: Rheumatoid arthritis; Tocilizumab; Adipokines; Endothelial function; Artrite reumatoide; Tocilizumabe; Adipocinas; Função endotelial; Artrite reumatoide; Função Endotelial; Adipocinas; CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::REUMATOLOGIA

Atherosclerotic disease is the leading cause of death in patients with rheumatoid arthritis (RA). The interpretation of the lipid profile in RA patients should be done in a cautious manner and should not be the only parameter for cardiovascular (CV) risk assessment as it can be falsely normal due to the so-called lipid paradox. The adipokines have been identified as potential biomarkers for CV outcome in the general population, but there is no study in RA population. Tocilizumab (TCZ) is a drug used in the treatment of RA with the potential of worsening the patient´s lipid profile, a finding with uncertain prognostic significance. The main objective of this study was to evaluate the behavior of serum adipokines (leptin, adiponectin and resistin) of RA patients at baseline and at 16 weeks of starting TCZ or conventional synthetic disease-modifying antirheumatic drugs (DMARD) treatment, methotrexate (MTX) or leflunomide (LEF). The secondary objectives were to correlate the serum adipokines levels´ with the serum levels of C-reactive protein (CRP) and with the disease activity score 28 joints (DAS28-CRP) and to evaluate the endothelial function, measured by flow-mediated dilatation (FMD). This is an observational, prospective cohort study, assessing RA patients over 18 years-old, of both genders, whom were initiating treatment either with TCZ or DMARD. The exclusion criteria were acute coronary syndrome in the last three months, uncontrolled arterial hypertension (SBP> 160 mmHg or DBP ≥110mmHg) and contraindication to the referred medications. The assessment of endothelial function was conducted by measuring flow-mediated dilatation (FMD). Forty two RA patients with moderate or severe disease activity participated in the study. In TCZ group, 18 patients were included with 1 loss (5.8%). In the DMARD group, 24 patients were included with 10 losses (41.66%). Six patients started on methotrexate (42.85 %%) and eight on leflunomide (63,15%). Leptin serum levels remained stable in both groups during the study period. The adiponectinemia ranged from 15.58 (IQR 12,22) to 20.60 (IQR 26,09), with p 0.06 in the TCZ group. Although resistin levels have not varied with statistical significance, there were significant monotonic linear correlation between resistin and FMD - Spearman rho -0.50 (p 0.04), resistin and DAS28 CRP - Spearman rho 0.49 (p 0.048), as well as resistin and CRP - Spearman rho 0.53 (p 0.03), in the TCZ group. In conclusion, in the 16th week of TCZ therapy there was an increase in adiponectin. There were also correlations between resistinemia and FMD, DAS28 CRP or CRP. However, further studies are needed to clarify whether resistin is only an inflammatory marker or actively participates in vascular damage.