Background/Purpose: Juvenile Idiopathic Arthritis (JIA) is one of the more common chronic diseases of childhood that often persists into adulthood and can result in significant long-term morbidity. Cardiovascular disease (CVD) is an important cause of mortality and morbidity in patients with rheumatoid arthritis and possibly other forms of adult inflammatory arthritis. However, the long-term risk of CVD for individuals with JIA remains uncertain Objective: To determine whether adults with JIA in remission and medium-long duration of the disease have an increased risk of CVD.

Methods: This is a cross-sectional study including 27 patients diagnosed with JIA according to the International League of Associations for Rheumatology criteria (ILAR 2001) were compared to 27 age- and sex-matched controls. Remission was determined by JADAS27<1 and according to Wallace criteria. An extensive clinical analysis including body index mass, lipid profile, HOMA-IR and intra-arterial blood pressure was performed. Intima media thickness of the common carotid artery (CIMT) was measured as a marker of subclinical atherosclerosis. Proinflammatory cytokines (TNFa, IL1b and IL6), molecules involved in endothelial dysfunction (VEGF, ICAM-1 and E-Selectin) and adipokines (leptin, adiponectin, resistin and visfatin) were analyzed on serum by ELISA

Results: Mean duration of the disease was 14.51 ± 2.20 years. Mean age was 29.31 ± 0.78. Time in remission was 4.22±0.64 years. Metabolic comordibities such as obesity and metabolic syndrome were more prevalent in our cohort of JIA patients compared to controls. Levels of cholesterol were significantly elevated in patients. CIMT was higher in JIA patients compared to controls, although it did not reach the statistical significance. Serum levels of cytokines (TNFa, IL6 and IL1b) and endothelial activation markers (VEGF and ICAM-1) were elevated in JIA adult patients. Serum levels of adiponectin were significantly decreased. In contrast, levels of resistin and visfatin were higher in JIA patients. Disease duration significantly correlated with CIMT values, cholesterol and TNFa levels. In addition, there was an association among levels of lipids, adipokines and inflammatory mediators.

Conclusion: In adult JIA patients with clinical remission, CMIT and levels of inflammatory cytokines, adipokines and endothelial activation markers were elevated, molecules with a relevant role in the onset and progression of endothelial dysfunction and atherosclerosis. These results might suggest that long-term JIA patients could have higher cardiovascular risk, although they are in sustained remission. Thus, cardiovascular risk assessment should be considered as part of routine clinical care in those patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cardiovascular-risk-factors-in-adults-with-juvenile-idiopathic-arthritis-in-sustained-remission/