New Treatment Possibilities for Patients with Rheumatoid Arthritis Combined with Anxiety and Depressive Disorders

Introduction. Patients with rheumatoid arthritis (RA) suffer from psychosocial maladaptation due to pain syndrome, limitation of activity with loss of ability to work and social connections. The presence of anxiety-depressive disorders (ADD) increases the incapacity of patients with RA in the first five years of illness from 25.0 to 50.0% Aim. Optimize RA treatment at an early stage (eRA) in combination with ADD, using a ramipril inhibitor of the angiotensin converting enzyme (ACE) in the treatment complex. Materials and methods. The examination of 179 patients with undifferentiated arthritis that was treated at the rheumatologic department of the Luhansk Regional Clinical Hospital revealed 95 people with eRA. The age of patients ranged from 22 to 59 years (on average, 41.27 ± 10.41 years), among them 16.8% of men and 83.2% of women aged 40.3 ± 9.22 years and 41.2 ± 10, 27 years old respectively. The duration of the disease – 1-28 months. RA diagnosis was verified according to the criteria of ASR/EULAR, 2010. The psychological status of all the patients was assessed using questionnaires of proven validity: the scale of hospital anxiety and depression (Hospital Anxiety and Depression Scale, HADS); the presence and severity of depression were assessed on Beck's scale. Results. It has been established that patients with eRA with ADD due to complex treatment using ramipril are likely to decrease the morning stiffness, the number of painful and edematous joints, the health status according to VAS and HAQ (p<0.001), the CRP level by 8 times, whereas after the treatment with a standard complex – only by 4 times (p<0.001). It is seen that ESR is almost three times as high as 1.75 (p<0.001) than after the standard complex, DAS28 decreases by 25.0%, TNF-α decreases by 25.0% after a comprehensive treatment with ramipril and 12.0% after the treatment without it. Also, the use of integrated treatment with ramipril improves the ultrasound scores of patients with eRA and ADD, namely, the decrease of the effusion into the cavity of the joints by 30.0% more than without it (p = 0.002), as well as the number of tenosinovites by 50.0% (p = 0.02), vascularization of the synovial membranes of 2nd and 3rd gradations (p = 0.002), increase in the number of patients without signs of synovial membrane vascularization (p = 0.04). Only in 6.7% of patients who received the standard treatment complex there were found new erosions, indicating the prevention of the appearing of the new erosions and the growth of joint destruction in patients with ramipril intake. The inclusion of ramipril in the treatment regimen for patients with eRA in combination with ADD contributes to a decrease in the number of points on the Beck's questionnaire from 22.37 ± 7.10 to 10.80 ± 2.90 (p<0.001), whereas without it – only from 22.36 ± 6.20 to 15.86 ± 3.20 points (p = 0.002). In 50.0 % of the patients, as a result of complex treatment with ramipril, the psycho-emotional state (total score on the Beck's questionnaire <10) was normalized compared with those who received treatment without it (p = 0.04). Copnclusions. Adding ramipril to the standard threatment course helps to improve the ultrasound picture, to decrease the articular syndrome and leads to the positive dynamics of the inflammatory markers. In patients with early RA the ultrasound of joints can determine the level of disease activity and is a promising noninvasive method of the pharmacotherapy monitoring.