oOaeCOa a aOaAeeiCe

eO?U O?EIAIAIE? IO‚OUUEI
®
(aAOOUUEI ) U O?EAIUO‚
O OEOUAIIOE I?OIOE ‚OI?IIOE
E ?A‚IUOEI?I ?U?EUOI

i.C. eOOIO‚, O?OUAOOO? a.e. AIAI·A?O‚, I.I.I. O.c. AIAIOI?O‚,
a.I.I.
?I.–IO??. eAac, O?OUAOOO? O.a. cOOIO‚
Ei aIOUEUUU ?A‚IUOIO„EE eAac, aOOI‚


Iaoa?eae e iaoiau
oa?ineea?ioe?aneia ii?a?aiea ninoaia e oaeea
A naycaiiua n iei inei?iaiey, eae eioa?eo ieiea?-
aa (EI) e einoeuo, yaey?ony ?anoie i?e?eiie i?a?aa- A enneaaiaaiea aee??aiu 30 iaoeaioia c ainoiaa?-
a?aiaiiie eaoaeuiinoe i?e o?iie?aneeo ainiaeeoaeu- iuie aeaaiicaie NEA [18] e 30 – ?A [19], a aic?anoa io
iuo ?aaiaoe?aneeo caaieaaaieyo – ?aaiaoieaiii 18 ai 55 eao. Iaoeaiou NEA e ?A auee ?acaaeaiu ia
a?o?eoa (?A) e nenoaiiie e?aniie aie?aiea (NEA) iiaa?oiiu ii 15 ?aeiaae: 1 iiaa?oiia (iniiaiay) iieo-
®
[1–4]. I?iaie?eoaeuiinou ?ecie o iaoeaioia n ?A ia ?aea eiaanoaoei (Iaainoaoei ) a oa?aiea 3–o ianyoaa a
2,5 aiaa iaiuoa, ?ai a iauae iiioeyoee, a a no?oeoo- aica 20 ia a nooee; 2–y iiaa?oiia (n?aaiaiey), niiinoa-
?a nia?oiinoe i?aiaeaaaao na?aa?ii–ninoaenoay ia- aeiay n iniiaiie ii iieo, aic?anoo, aeeoaeuiinoe e ae-
oieiaey [5]. I?e NEA o ?aiuei iieiaiai e n?aaiaai oeaiinoe caaieaaaiey, ia i?eieia?uay eiaanoaoei.
aic?anoa EI ?acaeaaaony a 50 ?ac ?aua, ?ai a iiioey- Oa?aeoa?enoeea aieuiuo NEA e ?A i?aanoaaeaia a oaa-
oee [6]. O iaoeaioia n NEA e ?A ?acaeoea aoa?ineea- eeoao 1 e 2. Aeoeaiinou caaieaaaiey o aieuiuo NEA
?ica ii?aaaeyaony ia oieuei eeanne?aneeie oaeoi?a- ioaieaaeanu ii oeaea SLEDAI [20], i?e ?A ?ann?eou-
ie ?enea, ii e eiioiiainiaeeoaeuiuie iaoiaaiaoe?a- aaeny eiaaen aeoeaiinoe DAS 28 [21]. A oa?aiea anaai
neeie iaoaieciaie yoeo caaieaaaiee. A nayce n yoei ia?eiaa i?eiaiaiey eiaanoaoeia aaciaay oa?aiey o ia-
i?ioeeaeoeea e ea?aiea ea?aeiaaneoey?iuo inei?ia- oeaioia n NEA (ae?eiei?oeeieau (AE), acaoeii?ei eee
iee i?e ?A e NEA yaeyaony ia iaiaa aa?iie i?iaea-
Oaaeeoa 1. Oa?aeoa?enoeea iaoeaioia n NEA
iie, ?ai ?ac?aaioea niaoeoe?aneeo iaoiaia oa?ia-
1 2
eioa?aiee naieo aieaciae.
() ()
Aey caiaaeaiey i?ia?anne?iaaiey aoa?ineea?ioe-
n=15 n=15
?aneiai ii?a?aiey ninoaia e nie?aiey ?enea ea?aeiaa-
Aic?ano (eao) 38 (22–51) 41,5 (34–50)
neoey?iuo eaoano?io eniieucoaony oe?ieee niaeo? ae-
Aeeoaeuiinou aieacie (ian.) 120 (24–360) 198 (14–456)
iieeieaaie?aneeo i?aia?aoia, n?aae eioi?uo iaeaieaa
Aica AE ia iiiaio
10 (5–30) 8 (4–30)
yooaeoeaiu noaoeiu (eiaeaeoi?u 3–aea?iene–3–iaoee-
enneaaiaaiey (ia/noo.)
aeooa?ee–eiyicei–A – (AIA–EiA)–?aaoeoacu) [7]. A Aeeoaeuiinou
108 (10–360) 126 (13–288)
iiiai?eneaiiuo eeeie?aneeo enneaaiaaieyo iieacaii, i?eaia AE (ian.)
?oi noaoeiu nie?a?o ?anoioo nia?oaeuiuo e iania?- SLEDAI (aaeeu) 2 (0–12) 2 (0–12)
oaeuiuo ei?iia?iuo inei?iaiee e einoeuoia, iacaaene- Aaiiua i?aanoaaeaiu a aeaa iaaeaiu e eioa?eaa?oeeuiiai ?aciaoa
ii io aic?anoa, iiea e iaee?ey niioonoao?uae iaoiei-
Oaaeeoa 2. Oa?aeoa?enoeea iaoeaioia n ?A
aee iaoeaioia [8–11]. A oi ?a a?aiy noaoeiu iaeaaa?o
1 2
ia oieuei aeiieeieaaie?aneeie naienoaaie, ii e i?i-
() ()
yaey?o ieaeio?iiiua yooaeou, naycaiiua a ia?ao?
n=15 n=15
i?a?aau n eo niiniaiinou? iiaaaeyou ?acaeoea ainia-
Iie (?/i) 13/2 12/3
eaiey [12–14]. ?ya aaoi?ia iieaaa?o, ?oi ea?aeii?ioae-
Aic?ano (eao) 48 (33–56) 51,5 (33–58)
oeaiia aaenoaea noaoeiia iaoneiaeaii a aieuoae noa-
Aeeoaeuiinou aieacie (ian.) 120 (3–288) 84 (6–360)
iaie i?ioeaiainiaeeoaeuiui, ?ai aeiieeieaaie?aneei
1 1
aaenoaeai [15,16,17]. ?aioaaiieiae?aneay 2 2 4
Oaeu enneaaiaaiey: ioaieou yooaeoeaiinou e ia- noaaey 3 10 8
®
?aiineiinou i?eiaiaiey eiaanoaoeia (Iaainoaoei ) – 4 2 3
eiaeaeoi?a AIA–EiA–?aaoeoacu a eiiieaeniii ea?aiee 1 10 9
OIN
NEA e ?A, eco?eou aai aeeyiea ia nenoaio o?ainii?oa 2 5 6
DAS 28 3,5 (1,8–5,5) 3,8 (1,9–6,9)
oieanoa?eia e?iae e iaeioi?ua ia?ea?u ainiaeaiey o
Aaiiua i?aanoaaeaiu a aeaa iaaeaiu e eioa?eaa?oeeuiiai ?aciaoa
iaoeaioia n NEA e ?A.


400 13, 7, 2005
oOaeCOa a aOaAeeiCe
oei ?eneii iaoeaioia e i?eaiii i?aia?aoa a ioiine-
ieaeaaiee) e n ?A (ianoa?ieaiua i?ioeaiainiaeeoaeu-
oaeuii iaaunieie aica, ainoaoi?iie oieuei aey ?aaee-
iua i?aia?aou, ieceea aicu AE, iaoio?aenao eee eao-
caoee aeiieeieaaie?aneiai yooaeoa. Iai?eia?, eia-
eoiiiea eee ieaeaaiee) ia iaiyeanu.
?ony aaiiua i oii, ?oi o iaoeaioia n naoa?iui aeaaa-
Eiioaio?aoey oieanoa?eia (ON), o?eaeeoa?eaia (OA),
oii 2 oeia ea?aiea aoi?aanoaoeiii a aica 80 ia/noo.
oieanoa?eia eeiii?ioaeaia aunieie ieioiinoe
i?eaaei e nie?aie? N?A a 56% neo?aaa, a a aica 10
(ON EIAI) ii?aaaeyee eiioiioo?aiaeiao?e?aneei ia-
ia/noo – oieuei o 23% iaoeaioia [26]. E?iia oiai, ii ia-
oiaii. Eiioaio?aoe? oieanoa?eia eeiii?ioaeaia iec-
oei aaiiui, ainoiaa?iie aeiaieee aeoeaiinoe NEA e
eie ieioiinoe (ON EIII) ?ann?eouaaee ii oi?ioea
?A a i?ioanna ea?aiey eiaanoaoeiii ia ioia?aii, ?oi
O?eaaaeuaa [22]. Eiaaen aoa?iaaiiinoe (EA) au?eneyee
oae?a, aa?iyoii, ieacaei aeeyiea ia ?acoeuoaou ii?a-
ii ioiioaie? o?iaiy ON EIII/ON EIAI. Eiioaio?a-
aaeaiey eiioaio?aoee N?A a aeiaieea.
oe? N–?aaeoeaiiai aaeea (N?A) ii?aaaeyee auniei?oa-
Iiai?iuo yooaeoia o iaoeaioia n NEA e ?A (eee
noaeoaeuiui (high sensitive) eiioiioa?iaioiui iaoi-
iaino?aiey caaieaaaiey) ia oiia ea?aiey eiaanoaoe-
aii (hsN?A) n eniieuciaaieai eiiia??aneeo iaai?ia
iii ioia?aii ia auei. Yoi iniaaiii aa?ii, iineieueo
oe?iu «Bender MedSystems GmbH» niaeanii eino?oe-
ii aaiiui eeoa?aoo?u ia oiia oa?aiee noaoeiaie aic-
oee ecaioiaeoaey. Enneaaiaaiea i?iaiaeee ai iacia?a-
ii?ii ?acaeoea aie?aii?ii–iiaiaiuo neia?iiia e ao-
iey eiaanoaoeia e iinea caaa?oaiey ea?aiey.
oieiioiiiai aaiaoeoa [27].
?acoeuoaou e iano?aaiea Oaeei ia?acii, iaoe i?aaaa?eoaeuiua ?acoeuoaou
naeaaoaeunoao?o i aunieii aeiieeieaaie?aneii
aaenoaee e oi?ioae ia?aiineiinoe eiaanoaoeia
Aeiaieea o?iaiae eeieaia e eeiii?ioaeaia e?iae o
(Iaainoaoei®) a aica 20 ia a noo. o iaoeaioia NEA e ?A.
iaoeaioia NEA i?aanoaaeaia ia ?enoiea 1. Eae aeaii ec
?enoiea, a a?oiiao iaoeaioia, iieo?aaoeo eiaanoaoei, I?ioeaiainiaeeoaeuiua e eiioiiiiaoee?o?uea yo-
ii n?aaiaie? n a?oiiie aac eiaanoaoeia ioia?aeinu ai- oaeou noaoeiia i?e NEA e ?A o?aao?o aaeuiaeoaai
noiaa?iia nie?aiea o?iaiae ON (ia 21%) e ON EIII (ia eco?aiey.
32%). Eiaaen aoa?iaaiiinoe oiaiuoeeny ia 35% a in-
aEUA?UU?
iiaiie a?oiia e ia 4% – a a?oiia n?aaiaiey (?<0,05).
1. Goodson N. Coronary artery disease and rheumatoid arthritis. Curr Opin Rheumatol.
?acee?ee a eiioaio?aoeyo OA e ON EIAI a n?aaieaaa-
2002; 14:115–120
iuo a?oiiao ioia?aii ia auei. Noiaiua ?acoeuoaou ii-
2. Salmon J.E., Roman M.J. Accelerated atherosclerosis in systemic lupus erythemato-
eo?aiu o iaoeaioia n ?A (?en. 2), a eiaiii – nie?aiea sus: implications for patients management. Curr Opin Rheumatol. 2001; 13:341–344
eiioaio?aoee ON, ON EIII e eiaaena aoa?iaaiiinoe ia 3. Bruce I.N., Gladman D.D., Urowitz M.B. Premature atherosclerosis in systemic lupus
12, 26 e 33% a iniiaiie a?oiia ii n?aaiaie? n 2, 1 e 2% erythematosus. Rheum Dis Clin North Amer. 2000; 26:257–278
4. cOOIO‚ O.a. e?O·IAI UAU?OI·OA ‚ ?A‚IUOIO„EE. CAOUIEI eAac 2003;7:6–10
n a?oiiie iaoeaioia, ia iieo?a?ueo eiaanoaoei, niio-
5. Van Doornum S., McColl G., Wicks I.P. Accelerated atherosclerosis. An extraarticular
aaonoaaiii. E?iia oiai, a iniiaiie a?oiia auyaeaii ai-
feature of rheumatoid arthritis? Arthritis Rheum 2002;46:862–873
noiaa?iia oaaee?aiea eiioaio?aoee ON EIAI (10%) 6. Manzi S., Wasco M.C. Inflammation – mediated rheumatic disease and atherosclero-
(?<0,05). Iaoe aaiiua i aeiieeieaaie?aneii aaenoaee sis. Ann Rheum Dis 2000;59:321–325
eiaanoaoeia i?e NEA e ?A noiaiu n oaeiauie o iaoeai- 7. Knopp R.H. Drug treatment of lipid disorders. New Engl J Med 1999;498–511
8. Chong P.H., Seeger J.D., Franclin C. Cliniccaly relevant differences the statins:implica-
oia n EAN [23]. Oaeaaua o?iaie eeieaia ia oiia i?ea-
tion for therapeutic selection. Am J Med 2001;111:390–400
ia eiaanoaoeia auee ainoeaioou o iieiaeiu iaoeaioia
9. La Roa J.C., He J., Vupputuri S. Effect of statins on risk of coronary disease. A
n NEA e ?A (oaae. 3). Meta–analysis of randomized controlled trials. JAMA 1999;282:2340–2346
Aaiiua eeoa?aoo?u, eana?ueany i?ioeaiainiaee- 10. Law M.R., Ward N.J., Rudnicka A.R. Quantifying effect of statin on low density
oaeuiuo e eiioiiiiaoee?o?ueo naienoa noaoeiia i?e lipoprotein cholesterol, ischemic heart disease, and stroke: systemic rewiev and
meta–analysis. BMJ 2003;326:1–7
NEA e ?A, e?aeia iaiiiai?eneaiiu. Oieuei a iaiii ia-
11. Salan A.M. Explanding indications of statins: implications of the Heart Protecion
aaaii i?iaaaaiiii ieaoaai–eiio?iee?oaiii enneaai-
Study. Exp. Opin Invest Drugs 2003;12:509–513
aaiee auei iieacaii, ?oi o iaoeaioia n ?A ia oiia ea- 12. Takemoto M., Liao J.K. Pleiotropic effects of 3–hydroxy–3methylglutaril coenzyme A
?aiey aoi?aanoaoeiii (40 ia/noo.) iaae?aaaony oia?ai- reductase inhibitors. Arteriol Tromb Vasc Biol 2001; 21:1712–1719
iia nie?aiea aeoeaiinoe caaieaaaiey (eiaaena DAS 28 13. Farmer J.A. Pleiotropic effects of statins. Curr Atherosclerosis report 2000;
2:208–217
ia 10%) e eiioaio?aoee N?A (ia 60%) [24]. A oi ?a a?a-
14. Munford R.S. Statins and the acute–phase response. New Engl J Med., 2001;
iy, ii aaiiui a?oaeo enneaaiaaoaeae, i?e ?A ia oiia
344:2016–2018
ea?aiey aoi?aanoaoeiii, oioy e iaae?aaaony ainoiaa?- 15. Case C.C., Ballantyne C.M. Statins and inflammatory markers. Curr Atherosclerosis
iay iiei?eoaeuiay aeiaieea iieacaoaey a?oa?eaeuiie Rep 2002; 4:42–47
?acenoaioiinoe, o?iaiy ON e ON EIII, ii yoi ia nii?i- 16. Callahan A.S. Vascular pleiotropy of statins: clinical evidence and biochemical mech-
anisms. Curr Atherosclerosis Rep 2003; 5:33–37
ai?aaaony ainoiaa?iie aeiaieeie eiioaio?aoee N?A
17. cOOIO‚ O.a. eA?OOAIUE‚? O?EIAIAIE? OUUEIO‚ ‚ ?A‚IUOIO„EE. eaU
[25]. A iaoai enneaaiaaiee ainoiaa?iiai nie?aiey
2003;11;23:1273–1276
o?iaiy N?A ia oiia ea?aiey eiaanoaoeiii a oaeii ii 18. Tan E.M., Cohen A.S., Fries J.F. The 1982 revised criteria for the classification of sys-
a?oiia iaoeaioia n NEA e ?A auyaeaii ia auei. Oai ia temic lupus erythematosus. Arthr. Rheum 1982; 25: 1271–1277
iaiaa i?e aiaeeca ioaaeuiuo iaae?aaiee nie?aiea 19. Arnrett F.C., Edworth S.M., Bloch D.A., et al. The American Rheumatism Association
1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum.,
o?iaiy N?A (aieaa ?ai ia 10% io enoiaiiai), ca?aaeno-
1988;31:315–324.
?e?iaaii o 7 ec 15 iaoeaioia n NEA e o 4 ec 15 – i?e ?A.
20. Bombardier C., Gladman D.D., Urowitz M.B. et al. The development and validation of
Ii–aeaeiiio, ionoonoaea ainoiaa?iie aeiaieee N?A the SLE disease activity index (SLEDAI). Arthritis Rheum., 1992;35:630–640.
i?e NEA e ?A a iaoai enneaaiaaiee naycaii n iaaieu- 21. Smolen J.S, Breedveld F.C, Eberl G, Jones I, Leeming M, Wylie G.L, Kirkpatrick J.
oOaeCOa a aOaAeeiCe
Validity and reliability of the twenty–eight–joint count for the assessment of rheumatoid
arthritis activity. Arthritis Rheum 1995;38:38–43.
22. Friedwald W.T., Levy R.J., Fredrickson D.S. Estimation of the calculation of LDL cho-
lesterol in plasma without use of the preparative ultracentrifuge. Clin. Chem. 1972; 18:
499–502.
23. Maron D.J., Fazio S., Linton M.F. Current perspectives on statins. Circulation
2000;101:207–213
24. McCarey DW, McInnes IB, Madhok R, inhibitors reduce plasminogen activator
inhibitor–Hampson R, Scherbakova O, Ford I, et al. Atorvastatin in Rheumatoid Arthritis
(TARA): a double–blind randomised placebo–controlled trial. Lancet 2004; 363:2015–21.
25. van Dorum S, McColl G, Wicks IP. Atorvastatin reduces arterial stiffness in patients
with rheumatoid arthritis. Ann Rheum Dis 2004; 63: 1571–1575.
26. van de Ree MA, Huisman MV, Princen HMG, et al. Strong decrease of high sensitive
C–reactive protein with high–dose atorvastatin in patients with type–2 diabetes mellitus.
Athrosclerosis 2003; 166: 129–135.
27. Kiani A.N., Petri M. Statin toxicity in the lupus atherosclerosis prevention study.
Arthritis Rheum 2003; 48: suppl: s370




Oaaeeoa 3. Iaoeaiou n NEA e ?A, ainoeaoea
oaeaauo o?iaiae eeieaia e eeiii?ioaeaia
e?iae ia oiia i?eaia eiaanoaoeia 20 ia/noo.
C (n=15) (n=15)
Iauee ON<5 iiieu/e (190 ia/ae) 9 9
ON EIII<5 iiieu/e (115 ia/ae) 9 8
ON EIAI>1 iiieu/e (40 ia/ae) 3 6


* ?<0,05




?en. 1. Eciaiaiea o?iaiy eeieaia e eeiii?ioaeaia e?iae
(%) i?e NEA




* ?<0,05




?en. 2. Eciaiaiea o?iaiy eeieaia e eeiii?ioaeaia e?iae
(%) i?e ?A




402 13, 7, 2005