Premature subclinical atherosclerosis in children and young adults with juvenile idiopathic arthritis. A review considering preventive measures

Abstract

Many studies show that Juvenile Idiopathic Arthritis (JIA) is associated with early subclinical signs of atherosclerosis. Chronic inflammation per se may be an important driver but other known risk factors, such as dyslipidemia, hypertension, insulin insensitivity, a physically inactive lifestyle, obesity, and tobacco smoking may also contribute substantially. We performed a systematic review of studies through the last 20 years on early signs of subclinical atherosclerosis in children and adolescents with JIA with the purpose of investigating whether possible risk factors, other than inflammation, were considered.We found 13 descriptive cross sectional studies with healthy controls, one intervention study and two studies on adults diagnosed with JIA. Only one study addressed obesity, and physical activity (PA) has only been assessed in one study on adults with JIA and only by self-reporting. This is important as studies on PA in children with JIA have shown that most patients are less physically active than their healthy peers, and as physical inactivity in several large studies of normal schoolchildren is found to be associated with increased clustering of risk factors for cardiovascular disease. It is thus possible that an inactive lifestyle in patients with JIA is an important contributor to development of the subclinical signs of atherosclerosis seen in children with JIA, and that promotion of an active lifestyle in childhood and adolescence may diminish the risk for premature atherosclerotic events in adulthood.

Physical Fitness in Patients With Oligoarticular and Polyarticular Juvenile Idiopathic Arthritis Diagnosed in the Era of Biologics: A Controlled Cross‐Sectional Study

“…In healthy children, low CRF is associated with subclinical cardiovascular disease (CVD) . Adequate CRF is important in children with JIA as the chronic inflammation is associated with early subclinical signs of atherosclerosis and, moreover, many have active disease into adulthood . Also, higher muscle strength is associated with lower CVD risk and better bone health in healthy children and adolescents .…”

Lipoprotein cholesterol fractions are related to markers of inflammation in children and adolescents with juvenile idiopathic arthritis: a cross sectional study

“…At present there is evidence that patients with JIA have an increased risk for early development of subclinical atherosclerosis [8, 9]. No long-term follow-up studies of adults with JIA have yet shown an increased risk of clinically important cardiovascular events in early adult life, underscoring that development of atherosclerosis is a complex process.…”

“…The clinical similarity between RA and JIA has given rise to several studies of the vasculature of patients with JIA, leaving no doubt that also JIA is associated with early signs of subclinical atherosclerosis [8, 9]. Persisting systemic inflammation may be a primary contributor, but other known risk factors for development of atherosclerosis, such as dyslipidemia, obesity, and sedentary behavior may contribute as well, and should be addressed prophylactically along with anti-inflammatory treatment.…”

Rheumatic Diseases and Endothelial Function

“…Как известно, ювенильный идиопатический артрит (ЮИА), начинаясь в детском возрасте, отличается непрерывным или рециди-вирующим течением и продолжается в последующие воз-растные периоды [75,76]. Закономерно предположить, что ЮИА, подобно ревматоидному артриту, является фак-тором риска развития ранних субклинических признаков атеросклероза [77]. По мнению E. Coulson и соавт.…”