Podolinskaya N.A., Vykhrystsenka L.R.
Diagnosing comorbidities of the abdominal cavity organs and abdominal region vessels in rheumatoid arthritis
Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
Vestnik VGMU. 2019;18(2):67-73.
Rheumatoid arthritis (RA) is associated with a high risk of comorbidities development.
Objectives. To verify and determine the occurrence frequency of pathological changes in arterial vessels of the abdominal region and diseases of the gastrointestinal tract (GIT) using ultrasound (US) in patients with RA.
Material and methods. 30 patients were examined (23 women and 7 men), their average age was 59.7+5.4 years, the duration of RA was 8.3+5.4 years. Ultrasonography of the abdominal cavity organs (AСO) and arterial vessels of the abdominal region was accompanied by deep palpation of the abdomen with the assessment of pain sensations according to visual analogue scale (VAS) with a gradation within the limits of 100 units. All patients underwent fibroesophagogastroduodenoscopy. The duration of the intake of nonsteroidal anti-inflammatory drugs was also taken into account.
Results. Comorbidity of AСO and abdominal vessels was diagnosed in the majority of patients with RA – 93.3% (28/30). It was represented by NSAID gastropathy in 83.3% of cases (25/30), atherosclerosis of the abdominal great vessels in 63.3% of patients (19/30), irritable bowel syndrome in 30% of cases (9/30), combined comorbidity was revealed in 73.3% of cases (22/30). In patients with RA over 45, comorbidities were more common (p<0.05). Atherosclerotic vascular lesion of the abdominal region was detected in 76% (20/25) of patients (p=0.008), NSAID gastropathy – in 84% (21/25) of cases (p=0.004) with high and medium RA activity. It has been established that the level of pain arising from the echo-controlled palpatory effect on the arterial vessels of the abdominal cavity in the position of atherosclerotic plaques, as well as in the projection of pathologically modified ACO, is an additional method of objectifying this pathology in patients (r=0.8; p<0.05) .
Conclusions. Comorbidity of AСO and abdominal vessels, including the combined one, is often found in patients with RA. RA activity and the age over 45 years exert a negative influence on the frequency of this pathology occurrence. Ultrasound investigation of the organs and arterial vessels of the abdominal region, conducted with the assessment of the severity of pain during deep palpation according to VAS, increases the clinical informativeness of the study.
Key words: rheumatoid arthritis, atherosclerosis, nonsteroidal anti-inflammatory induced gastropathy, irritable bowel syndrome, fibroesophagogastroduodenoscopy, ultrasound investigation.
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Information about authors:
Podolinskaya N.A. – lecturer of the General Practitioner Chair with the course of Polyclinic Therapy, Vitebsk State Order of Peoples’ Friendship Medical University;
Vykhrystsenka L.R. – Doctor of Medical Sciences, professor, head of the General Practitioner Chair with the course of Polyclinic Therapy, Vitebsk State Order of Peoples’ Friendship Medical University.