Lviv clinical bulletin 2015, 4(12): 42-47

https://doi.org/10.25040/lkv2015.04.042

Functional Activity Indicators of Phagocytic Cells in Peripheral Blood of Patients Diagnosed with Rheumatoid Arthritis Combined with Hypertension and its Change Under the Influence of Treatment

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V. Pekhenko

Bogomolets National Medical University, Kyiv

Introduction. The ratio of spontaneous vs. induced NBT-test neutrophils and monocytes is a reliable diagnostic criterion for evaluating the functional capacity of cells in the system of natural resistance. Thus the goal of our research was to determine the functional activity of phagocytic peripheral blood cells and changes in such activity under the influence of treatment in patients diagnosed with rheumatoid arthritis (RA), combined with arterial hypertension (AH).

Aim. To determine the functional activity of phagocyte cells of peripheral blood and its changes under the influence of treatment in patients with RA, combined with AH.

Materials and methods. 89 patients with RA and hypertension (25 male, 64 female, aged 35 to 65 years), were included into the research, after obtaining informed consent. All patients, (depending on the degree of RA activity), were stratified into three groups, which were accordingly prescribed different therapeutic complexes. The first group included 32 patients (8 male, 24 female, aged 36 to 65 years) with a minimum RA activity level (as DAS 28 < 3.2) who received methotrexate at a dose of 7.5 mg a week, an exacerbation glucocorticoids were administrated in initial dose of 15,0-20,0 mg with gradual reduction of 2.5 mg per week and remained at a maintenance dose of 2.5 or 5.0 mg till the end of the study.

The second group consisted of 30 patients (10 male, 20 female, aged 36 to 65 years) with a third-level active RA (index DAS 28 > 5.1), which had negative Mantoux test reaction, (i.e. they had no contraindications to use “Remiсade”) and who had received methotrexate at a dose of 7.5 mg a week and “Remiсade” at a dose of 3 mg/kg in/drip through infusomat at the beginning of treatment, then in 2 weeks, again in 6 weeks, and then every 8 weeks for 6 months; The third group was composed of 27 patients in total (7 male, 20 female, aged 35 to 64 years) who had a third- level active RA (index DAS 28 > 5.1), but had contraindications to use “Remiсade ” (due to positive Mantoux test) and therefore they received methotrexate from 15.0 mg (by 5.0 mg x 3) to 22.5 mg (7.5 mg x 3) a week.

Because the patients from the 2-nd and the 3-rd group had a third-level active RA, all of them also received an initial dose of glucocorticoids of 30,0-40,0 mg with further gradual reduction by 5.0 mg per week before the maintenance dose of 7,5-10, 0 mg was reached.

Results and discussion. Clinical effectiveness and safety evaluation of a therapy based on fixed combination of amlodipine and lisinopril (drug “Equator”, OAO “Gideon Richter” Hungary) had demonstrated its high efficiency in the treatment of RA patients with hypertension.

The comparative analysis of functional activity of neutrophilic granulocytes(FANG) and functional activity of monocytes (FAM) of patients in first and second groups vs. patients from third group made it possible to conclude that the use of adequate treatment allows to retain the functional activity of phagocytosed cell (for patients of the first and second groups) adaptive at a minimum level in response to microbial antigens E.coli. Under these conditions, the preservation of functional ability of monocytes, as the main link of immune system’s antigen cells presentation, reduces the formation of immunosuppression and autoimmune reactions in patients of first and second groups. These trends were less vivid in patients of the third group.

Conclusions. Thus, if the adequate therapy for RA is prescribed, the functional activity of phagocytosed cells is retained in the adaptive minimum level, and the preservation of functional ability of monocytes, as the main link of immune system’s antigen cells presentation, reduces the formation of immunosuppression and autoimmune reactions.

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