Assessment of vascular function in systemic onset juvenile idiopathic arthritis

Abstract

An increased incidence of cardiovascular disease has been found in rheumatic disorders. Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children. Prolonged immunological inflammatory process leads these patients to an early onset of atherosclerosis. We aimed to assess the presence of early vascular dysfunction in patients with systemic onset juvenile idiopathic arthritis (sJIA) and investigate the role of therapy sJIA in vascular health. Thirty-three patients (22 males, 11 females) diagnosed with sJIA according to the International League of Associations for Rheumatology criteria were compared to 72 age- and sex-matched controls. None of the participants was overweight, obese, or had a history of hypertension, dyslipidemia, diabetes mellitus, or cardiovascular disease. Arterial stiffness (As) was evaluated by measurement of carotid-femoral pulse wave velocity (PWV) and augmentation index (AIx) with a Vicorder. The mean age of patients in this study was 9.96 ± 3.71 years (range 4-16 years) and the mean age of controls was 10.9 ± 3.52 years (range 4-19 years). These two groups were well matched for age, sex, and BMI. The mean age of patients at the onset of disease was 7.06 ± 3.9 years (range 3-15 years). The mean duration of disease and active disease was 79 ± 45 months (range 6-162 months) and 58 ± 49 months (range 1-101 months), respectively. The highest levels of PWV and AIx were found in the patient group. Seven patients had had macrophage activation syndrome at presentation. In these patients, vascular changes were higher than other patients (6.30 ± 0.42 m/s vs 5.17 ± 0.55 m/s, p = 0.01, respectively). The corticosteroid therapy was found associated with higher PWV, (p < 0.05), while there was no difference between vascular parameters and use of non-steroid therapies (methotrexate (MTX), anti-TNF alfa agents). We also find statistically significant correlation between PWV and disease duration (p = 0.003, r = 0.45). Vascular function is impaired in patients with sJIA at a very young age. Vascular dysfunction may be partly attributed to the effects of disease-related characteristics (inflammation, disease activity, and medications).

Risk Factors to Pre-Clinical Atherosclerosis Evaluated by Carotid Intima-Media Thickness in Juvenile Idiopathic Arthritis: Descriptive Research

“…19,23 Sozeri et al found that PWV and AIx considered direct and indirect signs of arterial stiffness higher in patients during the active stage of systemic JIA. 24 In our study, we could not detect any difference in the CIMT values of patients during the active disease stage. We believe that this should be further investigated in patient groups during active and remission stages, with more homogeneously disturbed age and disease subgroups.…”

Pulmonary involvements in systemic juvenile arthritis

“…Two patients concurrent with sJIA-LD during the MAS phase have been found to have vascular involvements, including cerebral venous sinus thrombosis or coronary artery lesions. Vascular function is impaired in patients with sJIA at a very young age, showing increased arterial stiffness, especially in those presenting with MAS [7] . Vascular endothelial cells are activated by in ammatory cytokines and further contribute to the intravascular coagulation of sJIA.…”

Inflammation as A Precursor of Atherothrombosis, Diabetes and Early Vascular Aging

“…AS is hypertension independent in patients with chronic kidney disease or inflammatory disease, as shown by AS reduction with anti-TNF-α therapy, without changes in blood pressure levels [163]. AS also appears from a very young age in patients with inflammatory diseases [164]. Vulnerable individuals are at risk of early development of complications usually expected later in life.…”