NT-proBNP in Rheumatoid Arthritis Patients: Interaction of Immuno-inflammatory Process and Cardiovascular System

This article describes the data about diagnostic and prognostic value of the N-terminal fragment of the brain natriuretic propeptide (Nt-proBNP) in patients with rheumatoid arthritis (RA) based on the results of international studies, generally accepted international recommendations, modern scientific publications and results of the own research.Patients with RA are known to have a 2-fold higher mortality rate from cardiovascular disease (CVD) and its complications comparing to the general population. Nt-proBNP is commonly used as a diagnostic criteriafor heart failure (HF) and left ventricular dysfunction, and to monitor the effectiveness of treatment for HF. At the same time, modern studies have shown that in RA patients this marker is elevated without clinical or instrumental signs of CVD or HF, which makes impossible to use the level of Nt-proBNP with sufficient degree of certainty for diagnosis of HF in this cohort of patients. The evaluation of the role of Nt-proBNP as a marker of cardiovascular involvement or as a part of the immuno-inflammatory response in RA patient need further researches.We conducted the study to determine the level of Nt-proBNP in RA patients without CVD/HF and found its increased level in 75 % of these patients with the mean level of 3090±2710 pg/ml compared to healthy subjects of the same age and gender – 14,2 % and mean level of 565±430 pg/ml (p<0,001).Among RA patients without clinical an instrumental signs of CVD /HF the increased level of Nt-proBNP is more frequent and increase is grater than in healthy subjects, which could be connected to the role of this peptide in immune inflammation and pathogenesis of RA.