The experience of using dark-field microscopy to assess damage to the endothelial glycocalyx in rheumatoid arthritis

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Abstract


Rheumatoid arthritis is the most common inflammatory joint disease and one of the most common chronic inflammatory diseases. The leading role in the pathogenesis of rheumatoid arthritis is the damage to the endothelial glycocalyx — a thin dynamic layer of macromolecules located on the surface of the endothelium and consisting of proteoglycans, glycoproteins and glycosaminoglycans, which contributes to the maintenance of rheumatoid arthritis activity. Therefore, early detection of violations of the vasculr endothelium condition, especially the endothelial glycocalyx, will identify a group of patients with a poor prognosis. In this context, the method of dark-field microscopy may be promising. It allows non-invasive and in vivo assessment of the thickness of the sublingual endothelial glycocalyx, which will make it possible to search for new unconventional risk factors for the unfavorable course of rheumatoid arthritis and cardiovascular risk in these patients, as well as personalize treatment by developing a complex of preventive and therapeutic measures aimed at restoring endothelial function, reducing the risk of cardiovascular complications, disability and mortality from rheumatoid arthritis. The unique capabilities of this research method are demonstrated by the example of the clinical case.


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About the authors

Timur D. Vlasov

The First Pavlov State Medical University of St. Petersburg

Email: tvlasov@yandex.ru
ORCID iD: 0000-0002-6951-7599
SPIN-code: 8367-1246

Russian Federation, Saint Petersburg

Dr Sci. (Med.), professor, head of the Department of Pathophysiology with a course of clinical pathophysiology

Daniel A. Shimanski

The First Pavlov State Medical University of St. Petersburg

Author for correspondence.
Email: next184@list.ru
ORCID iD: 0000-0002-6903-2217
SPIN-code: 2022-5223
ResearcherId: AAW-1441-2020

Russian Federation, Saint Petersburg

post-graduate student of the Department
of Hospital Therapy with a course of Allergology and Immunology named after acad. M. V. Chernorutsky with a clinic

Irina I. Nesterovich

The First Pavlov State Medical University of St. Petersburg

Email: nester788@gmail.com

Russian Federation, Saint Petersburg

Dr Sci. (Med.), professor of the Department of Hospital Therapy with a course of Allergology and Immunology named after acad. M. V. Chernorutsky with a clinic

Vasilii I. Trophimov

The First Pavlov State Medical University of St. Petersburg

Email: trofvi@mail.ru

Russian Federation, Saint Petersburg

Dr Sci. (Med.), professor, head of the Department of Hospital Therapy with a course of Allergology and Immunology named after acad. M. V. Chernorutsky with a clinic

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Supplementary files

Supplementary Files Action
1.
Fig. 1. An arterial occlusion test with laser Doppler flowmetry. LDF-gram before (on the left) and after (on the right) sampling with short-term arterial occlusion. The area of study is the locus of the anterior surface of the distal third of the forearm skin. The abscissa shows the values of the microcirculation index (MI), measured in perfusion units, the ordinate — time scale

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2.
Fig. 2. A test with iontophoresis of 0.1% acetylcholine solution with laser Doppler flowmetry. LDF-gram before (above) and after (below) the application of 0.1% acetylcholine solution. The area of study is the locus of the anterior surface of the distal third of the forearm skin. The abscissa shows the values of the microcirculation index, measured in perfusion units, the ordinate — time scale

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Copyright (c) 2021 Vlasov T.D., Shimanski D.A., Nesterovich I.I., Trophimov V.I.

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