{
  "abstract": "Introduction Systemic sclerosis (SSc) is a rare connective tissue disease characterized by chronic inflammation and fibrosis of the skin, vascular abnormalities and variable involvement of organs. TNF-alfa has a central role in initial host response in the pathogenesis of various systemic immune-mediated diseases. Serum levels of TNF-alfa are elevated in patients with SSc and favor the development of pulmonary fibrosis and pulmonary arterial hypertension. The serum levels of TNF-alfa may promote the progression of the endothelial dysfunction. TNF-alfa inhibitors reduce the systemic inflammation, improve the endothelial function decreasing the risk of pulmonary arterial hypertension progression and of acute cardiovascular events. Available therapies for the treatment of SSc with proven efficacy are unfortunately few However, a potential role of TNF-alfa inhibitors in the treatment of SSc is suggested by the overexpression of TNF-alfa in this chronic immunomediated disease.Objectives To study the association of serum TNF-alpha levels with the main clinical manifestations and activity of SSc.Material and Methods 66 patients with SSc-ILD verified by MSCT were enrolled into the study (disease duration 7.2±5.6 years, diffused/limited SSc 1.7/1, average age 50.3 ± 12.6 years, females 77%). All patients received low or moderate dose glucocorticoids and immunosuppressants, 45 (68%) received rituximab (RTM) at cumulative dose 2.4±1.5 grams. The level of TNF-alpha was determined by the ELISA method. Subsequently correlation analysis was made to clarify the association of the TNF-alpha level with the main clinical manifestations, activity of SSc (EScSG, points), laboratory parameters (ESR, CRP, ANA-HEP-2, a-Scl-70, B cell count).Results There was a significant correlation between TNF-alpha levels and the progression of vascular disorders (r=0.43), including digital scars (r=0.27), ulcers (r=0.28) and necrosis (r=0.34), the presence of cardiopathy (r=0.31), proteinuria (r=0.37), and SSc activity (r=0.37). There was no correlation of TNF-alpha levels with indicators of inflammatory and immunological activity and indicators of functional pulmonary tests. However, an inverse correlation of TNF-alpha levels with the development of pulmonary fibrosis was revealed according to MSCT data (r=-0.53).Conclusions The serum levels of TNF-alfa may promote the progression of the endothelial dysfunction. Randomized controlled trials with TNF-alfa inhibitors in patients with SSc are needed to confirm the potential role of these agents in the treatment of patients with peripheral vascular disorders and without interstitial lung disease.",
  "authors": [
    {
      "affiliations": [
        "V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia"
      ],
      "name": "Olga Koneva"
    },
    {
      "affiliations": [
        "V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia"
      ],
      "name": "Rushana Shayachmetova"
    },
    {
      "affiliations": [
        "V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia"
      ],
      "name": "Liudmila Garzanova"
    },
    {
      "affiliations": [
        "V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia"
      ],
      "name": "Anastasia Avdeeva"
    },
    {
      "affiliations": [
        "V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia"
      ],
      "name": "Michail Diatroptov"
    },
    {
      "affiliations": [
        "V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia"
      ],
      "name": "Olga Ovsyannikova"
    },
    {
      "affiliations": [
        "V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia"
      ],
      "name": "Lidia Ananyeva"
    }
  ],
  "title": "P.196 Clinical and laboratory associations of TNF-alfa in patients with systemic scleroderma",
  "uid": "b9c471fe-cf0c-5cd3-8f5e-347f3de1fc1c"
}