Anti-Inflammatory Phenotyping of Chronic Heart Failure in Patients with Rheumatoid Arthritis, Depending on The Options of Basic Anti‑Inflammatory Therapy

Aim: To determine the characteristics of the course of chronic heart failure (CHF) against the background of rheumatoid arthritis (RA) by conducting a comparative analysis of laboratory, instrumental, and clinical indicators of CHF in patients with RA and those without RA, as well as to identify possible associations between basic anti‑inflammatory therapy and the parameters under study. Materials and Methods: The study included 256 patients (all study participants were women): the study group consisted of 134 patients with CHF and RA, and the comparison group consisted of 122 patients with CHF without RA. The functional class of CHF in the study groups was NYHA I–II. The diagnosis of CHF was made based on the current criteria. The diagnosis of RA was confirmed using laboratory and instrumental criteria. A comparative assessment of clinical and laboratory parameters was carried out in the study groups. An analysis was conducted of possible associations between basic anti‑inflammatory therapy for RA and indicators of the disease course. The paper presents statistically significant results. Data processing was carried out using the Statistica 10.0 software. The critical significance level for testing statistical hypotheses was p < 0.05. Results: The study showed that patients with RA have higher E/e ratios, blood pressure, and worse lipid profile and GFR values, which is likely associated with systemic inflammation. At the same time, the NT‑proBNP level turned out to be lower than in the comparison group. The comparison of therapies revealed that taking methotrexate (as opposed to leflunomide) helps to reduce the NT‑proBNP level, improve the E/e` ratio, and reduce symptoms of heart failure, which confirms the cardioprotective effect of methotrexate in RA. Conclusion: Taking methotrexate at a dosage of 15 mg/day may have a positive effect on such parameters as E/e` and NT-proBNP in patients with CHF and RA. However, prospective studies are needed to confirm this hypothesis.