ULTRASOUND DIAGNOSTICS OF THE LIVER AS AN EFFECTIVE METHOD OF CONTROLLING NON-ALCOHOLIC FATTY LIVER DISEASE THERAPY IN RHEUMATOID ARTHRITIS PATIENTS

Iryna Klymas

doi:10.23856/5928

Iryna Klymas Shupyk National Healthcare University of Ukraine https://orcid.org/0000-0002-1142-5958

Keywords: liver steatosis, autoimmune inflammation, dyslipidemia, non-invasive diagnostics, atorvastatin, essential phospholipids.

Abstract

Today, the method of ultrasound diagnostics is the most widespread method of internal organs and tissues visualization. In particular, the liver ultrasound is the safest and most informative method of diagnosing non-alcoholic fatty liver disease (NAFLD) and an effective method of monitoring the effectiveness of NAFLD treatment, namely its manifestation of liver steatosis. The aim of this paper was to investigate the changes in the state of the liver by ultrasound in rheumatoid arthritis (RA) patients with the use of additional combined therapy of atorvastatin and essential phospholipids. We were examined and treated 77 RA patients with NAFLD (64 women (83.1%) and 13 men (16.9%)), under the age of 55 years old. The patients were divided into 3 studied groups. The first group (n=25) received additional atorvastatin, the second group (n=26) – essential phospholipids, and the third group (n=26) – combination of atorvastatin and essential phospholipids for 6 months. Ultrasound assessment of steatosis was performed before treatment, after 3 and 6 months of treatment. In the III group, an improvement of the ultrasound images was observed already after 3 months of combined use of atorvastatin and essential phospholipids, which was not observed in the separate use of these medicines in the I and II groups. In 6 months of treatment with the studied medicines, positive dynamics of the liver parenchyma echogenicity was observed in all studied groups.

References

1. Aithal G. P. (2011). Hepatotoxicity related to antirheumatic drugs. Nature reviews. Rheumatology, 7(3), 139–150. https://doi.org/10.1038/nrrheum.2010.214
2. Alkhouri, N., & Feldstein, A. E. (2016). Noninvasive diagnosis of nonalcoholic fatty liver disease: Are we there yet?. Metabolism: clinical and experimental, 65(8), 1087–1095. https:// doi.org/10.1016/j.metabol.2016.01.013
3. Castera, L., Friedrich-Rust, M., & Loomba, R. (2019). Noninvasive Assessment of Liver Disease in Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology, 156(5), 1264–1281. e4. https://doi.org/10.1053/j.gastro.2018.12.036
4. Karlsson Sundbaum, J., Eriksson, N., Hallberg, P., Lehto, N., Wadelius, M., & Baecklund, E. (2019). Methotrexate treatment in rheumatoid arthritis and elevated liver enzymes: A long-term follow-up of predictors, surveillance, and outcome in clinical practice. International journal of rheumatic diseases, 22(7), 1226–1232. https://doi.org/10.1111/1756-185X.13576
5. Papatheodoridi, M., & Cholongitas, E. (2018). Diagnosis of Non-alcoholic Fatty Liver Disease (NAFLD): Current Concepts. Current pharmaceutical design, 24(38), 4574–4586. https:// doi.org/10.2174/1381612825666190117102111
6. Pennisi, G., Celsa, C., Giammanco, A., Spatola, F., & Petta, S. (2020). The Relevance of Noninvasive Tools To Assess Fibrosis in Non-Alcoholic Fatty Liver Disease. Current pharmaceutical design, 26(32), 3928–3938. https://doi.org/10.2174/1381612826666200521133307
7. Radovanović-Dinić, B., Tešić-Rajković, S., Zivkovic, V., & Grgov, S. (2018). Clinical connection between rheumatoid arthritis and liver damage. Rheumatology international, 38(5), 715–724. https://doi.org/10.1007/s00296-018-4021-5
8. Sellami, M., Saidane, O., Mahmoud, I., Tekaya, A. B., Tekaya, R., & Abdelmoula, L. (2020). Etiological Features of Liver Involvement in Rheumatoid Arthritis. Current rheumatology reviews, 16(4), 332–336. https://doi.org/10.2174/1573397115666191007121605
9. Vassiliadis, E., Oliveira, C. P., Alvares-da-Silva, M. R., Zhang, C., Carrilho, F. J., Stefano, J. T., Rabelo, F., Pereira, L., Kappel, C. R., Henriksen, K., Veidal, S. S., Vainer, B., Duffin, K. L., Christiansen, C., Leeming, D. J., & Karsdal, M. (2012). Circulating levels of citrullinated and MMP-degraded vimentin (VICM) in liver fibrosis related pathology. American journal of translational research, 4(4), 403–414.
10. Wendt, M. M. N., de Oliveira, M. C., Franco-Salla, G. B., Castro, L. S., Parizotto, Â. V., Souza Silva, F. M., Natali, M. R. M., Bersani-Amado, C. A., Bracht, A., & Comar, J. F. (2019). Fatty acids uptake and oxidation are increased in the liver of rats with adjuvant-induced arthritis. Biochimica et biophysica acta. Molecular basis of disease, 1865(3), 696–707. https://doi. org/10.1016/j.bbadis.2018.12.019
11. Wheeler, P. G., Theodossi, A., Pickford, R., Laws, J., Knill-Jones, R. P., & Williams, R. (1979). Non-invasive techniques in the diagnosis of jaundice--ultrasound and computer. Gut, 20(3), 196–199. https://doi.org/10.1136/gut.20.3.196
12. Zamani, M., Alizadeh-Tabari, S., Chitkara, P., Singh, S., & Loomba, R. (2023). Prevalence of Nonalcoholic Fatty Liver Disease in Patients With Rheumatoid Arthritis: A Systematic Review and Meta-analysis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 21(11), 2789–2796. https:// doi.org/10.1016/j.cgh.2023.02.021
13. Zhou, J. H., Cai, J. J., She, Z. G., & Li, H. L. (2019). Noninvasive evaluation of nonalcoholic fatty liver disease: Current evidence and practice. World journal of gastroenterology, 25(11), 1307–1326. https://doi.org/10.3748/wjg.v25.i11.1307