Disruption of endothelial glycocalyx in patients with rheumatoid arthritis

BACKGROUND: Endothelial glycocalyx has an important role in the regulation of endothelial functioning. It is the first to be damaged during the development of autoimmune inflammatory diseases. Thinning of endothelial glycocalyx leads to a violation of the barrier function of blood vessels, the development and maintenance of the inflammatory process. In this context, using endothelial glycocalyx assessment for diagnostic and monitoring of diseases is considered of great interest.

AIM: To establish the relationship between endothelial glycocalyx thickness with activity, serological profile and risk factors for an unfavorable course of rheumatoid arthritis.

MATERIALS AND METHODS: The study included 76 patients from 18 to 65 years of both sexes with rheumatoid arthritis. The perfusion boundary region of endothelial glycocalyx determined using a dark-field microscope has been used as the main indicator for assessing the state of endothelial glycocalyx.

RESULTS: The obtained results have demonstrated a decrease in the initial endothelial glycocalyx thickness in females in the presence of risk factors for an unfavorable course of rheumatoid arthritis. At the same time, no relationship with the serological profile and endothelial glycocalyx thickness has been found. An inverse correlation between endothelial glycocalyx thickness and syndecan-1 level and erythrocyte sedimentation rate has been found. This confirms the fact that endothelial glycocalyxes are involved in the inflammatory process in rheumatoid arthritis. Endothelial glycocalyx assessment using dark-field microscopy made it possible to predict the subsequent appointment of pulse therapy with methylprednisolone in the hospital. On re-examination, endothelial glycocalyx thinning has been observed in the presence of unfavorable risk factors for the course of rheumatoid arthritis, in negative to anti-cyclic citrullinated peptide antibodies patients, or in the absence of response to treatment.

CONCLUSIONS: The use of dark-field microscopy is unique in its capabilities for intravital and non-invasive assessment of endothelial glycocalyx thickness. It provides important fundamental information deepening knowledge in the pathological physiology of disease. From a clinical point of view, it allows to consider a decrease in endothelial glycocalyx thickness as an additional prognostically unfavorable marker in rheumatoid arthritis.