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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. 1 ACVD and CKD remain the main causes of mortality in rheumatoid arthritis (RA) patients. 2,3
Objectives: 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.
Cardiorenal continuum of rheumatoid arthritis patients (%)
| Features | Rituximab group | Control group | p RTM–C | ||||
|---|---|---|---|---|---|---|---|
| 1 year n=92 | 3 years n=47 | 6 years n=31 | 1 year
| 3 years n=26 | 6 years n=16 | ||
| Risk factors | |||||||
| Hypertension | 52.2 | 38.3 | 25.8
| 50.0 | 38.5 | 50.0 | p6=0.032 |
| Dyslipidaemia | 44.6 | 36.2 | 38.7 | 48.0 | 46.2 | 50.0 | >0.05 |
| Pre-diabetes | 41.3 | 36.2 | 41.9 | 44.0 | 34.6 | 56.3 | >0.05 |
| Metabolic syndrome | 12.0 | 6.4 | 3.2 | 10.0 | 7.7 | 12.5 | >0.05 |
| Diabetes mellitus | 3.2 | 0 | 0 | 2.0 | 0 | 0 | >0.05 |
| Anxiety/
| 78.3 | 41.5
| 35.3
| 76.0 | 73.1 | 68.8 | p3=0.009
|
| Initial stages (asymptomatic organ damage) | |||||||
| Atherosclerosis | 34.8 | 21.3 | 12.9
| 36.0 | 34.6 | 37.5 | p6=0.02 |
| Left ventricular hypertrophy | 8.7 | 4.3 | 0 | 8.0 | 7.7 | 0 | >0.05 |
| Diastolic dysfunction | 57.6 | 38.3 | 22.6
| 56.0 | 50.0 | 56.3 | p6=0.04 |
| Albuminuria | 19.6 | 0 | 0
| 12.0 | 0 | 6.3 | >0.05 |
| Kidney impairment | 6.5 | 2.1 | 0 | 6.0 | 0 | 0 | >0.05 |
| Progression | |||||||
| Angina | 6.5 | 0 | 0 | 4.0 | 0 | 0 | >0.05 |
| Chronic kidney disease | 26.1 | 8.5 | 9.7
| 12.0 | 0 | 0 | >0.05 |
| End stage | |||||||
| Myocardial infarction | 0 | 0 | 0 | 0 | 0 | 0 | >0.05 |
| Stroke | 0 | 0 | 0 | 0 | 0 | 0 | >0.05 |
| Heart failure | 4.4 | 0 | 0 | 0 | 0 | 0 | >0.05 |
| Acute/chronic renal failure | 0 | 0 | 0 | 0 | 0 | 0 | >0.05 |
| Death | 0 | 0 | 0 | 0 | 0 | 0 | >0.05 |
There 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 Dis 2000;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 Rheum 2008;59:1690–7.
[3]Gullick NJ, Scott DL. Co-morbidities in established rheumatoid arthritis. Best Pract Res Clin Rheumatol 2011;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