Статья
Хроническая сердечная недостаточность у больных ревматоидным артритом (часть III): влияние противоревматической терапии
Хроническое аутоиммунное воспаление – один из ведущих факторов риска развития хронической сердечной недостаточности (ХСН) при ревматоидном артрите (РА). Целью обзора литературы явился анализ результатов работ, посвященных влиянию синтетических базисных противовоспалительных препаратов (с-БПВП), генно-инженерных биологических препаратов и таргетных с-БПВП на функцию сердца и риск развития ХСН у пациентов с РА. Метотрексат может снижать риск и положительно влиять на течение ХСН у пациентов с РА. Несмотря на данные о наличии у лефлуномида эффектов, препятствующих ремоделированию миокарда, отсутствуют доказательства роли препарата в профилактике ХСН у больных РА. Гидроксихлорохин может способствовать профилактике ХСН, однако следует учитывать риск развития тяжелой кардитоксичности при длительном приеме препарата. В большинстве исследований не выявлено отрицательного влияния ингибиторов фактора некроза опухоли α на распространенность и частоту возникновения новых случаев ХСН у больных РА, показано улучшение структуры и функции сердца на фоне терапии. Ингибиторы интерлейкина (ИЛ)-1, ингибиторы ИЛ-6, ингибиторы ко-стимуляции Т-клеток, анти-В-клеточная терапия, таргетные с-БПВП не увеличивают риск ХСН и могут оказывать кардиопротективные эффекты, в том числе, замедлять прогрессирование дисфункции миокарда левого желудочка. В связи с высоким риском ХСН и ХСН-ассоциированной летальности у больных РА необходима ее ранняя диагностика, разработка стратегии профилактики и лечения. Целесообразно проведение проспективных исследований высокого качества для оценки влияния противоревматической терапии на функцию миокарда, риск развития и декомпенсации ХСН у больных РА. Возможно, некоторые препараты способны оказывать положительные эффекты на кардиомиоциты, и станут средствами первой линии у пациентов с ХСН или риском ее развития.
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