Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Increased cardiovascular mortality and morbidity have been observed in adults with Rheumatoid Arthritis. The long-term risk of cardiovascular disease for individuals with Juvenile Idiopathic Arthritis (JIA) remains uncertain. This study aims to determine whether adults with JIA have an increased risk of cardiovascular disease compared to the general population.
Methods:
51 patients with JIA (mean age 35.6 years, SD 13.23) were compared to 26 controls (mean age 37.3 years, SD 13.14). Data regarding traditional cardiovascular risk factors were collected including fasting blood glucose and lipid profile, blood pressure, BMI and history of hypertension, hypercholesterolaemia, diabetes mellitus, smoking history and family history of cardiovascular disease. Disease sub-type (ILAR criteria) and duration were recorded. In the patient group the sub-types were as follows: systemic 3/51 (5.9%), enthesitis-related arthritis (ERA) 5/51 (9.8%), extended oligoarticular 12 /51 (23.5%), polyarticular 27/51 (52.9%), juvenile psoriatic (JPSA) 4/51 (7.8%). Median disease duration was 24 years (3-57). Many (23/51 (45%)) patients were taking biological therapy, 13 as monotherapy and 10 in combination with a DMARD; a further 17/51 (33%) patients were taking one or more DMARDs. Common carotid artery intima-media thickness (CCA IMT) was examined by B-mode ultrasound (Toshiba AplioXU and 12 MHz transducer) as a surrogate marker of cardiovascular disease. Images were analysed blinded using the M’athñ software package (Intelligence in Medical Technologies). Continuous, parametric variables were analysed using the independent samples T-test, non-parametric using the Mann Whitney U test and categorical data using the chi-squared test.
Results:
The Table shows that a significantly higher proportion of patients had a pre-existing diagnosis of hypertension compared to controls (p=0.029) but no significant differences in other pre-existing traditional cardiovascular risk factors. The patient group had a significantly higher CRP (p=0.006). No significant differences were found in ESR, fasting glucose or lipid levels, BMI or systolic or diastolic blood pressures recorded in clinic. CCA IMT showed good correlation with age (Pearson’s coefficient 0.76, p=0.000). The patient group had a significantly higher mean CCA IMT (0.54 vs. 0.49, p=0.037) compared to controls. Subgroup analysis revealed a significantly higher mean CCA IMT in those with polyarticular disease (0.56 vs. 0.48, p=0.01), but not for other subtypes. CCA IMT was not significantly higher in patients taking biologics (0.51 vs. 0.49 p=0.396) but was for those taking DMARDs (0.58 vs. 0.48, p=0.029) compared to controls.
Conclusion:
Adults with JIA were found to have an increased cardiovascular risk measured using carotid IMT compared to age- and sex-matched controls. This may in part be explained by an increased prevalence of hypertension.
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Patient n=51
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Control n=26
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P value
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Hypertension n(%)
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12 (23.5)
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1 (3.9)
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0.029
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Hypercholesterolaemia n(%)
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4 (7.8) |
1 (3.9) |
0.501
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Diabetes mellitus n(%)
|
2 (3.9) |
1 (3.9) |
0.987
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Family history of cardiovascular disease n(%)
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6 (11.8) |
3 (11.5) |
0.771
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Smoking history n(%)
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Ever |
12 (23.5) |
Ever |
3 (11.5) |
0.305
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Never |
39 (76.5) |
Never |
23 (88.5) |
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Pack Years (mean) |
10.4 |
8.5 |
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CRP (mg/l) mean (SD)
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9.0 (9.02)
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5.6 (1.97)
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0.006
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ESR (mm/hr) mean (SD) |
12.6 (12.75) |
6.4 (7.70) |
0.106
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BMI (kg/m2) mean (SD) |
25.0 (6.5) |
24.9 (4.3) |
0.483
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Systolic BP (mmHg) mean (SD) |
122 (15.4) |
120 (14.0) |
0.684
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Diastolic BP (mmHg) mean (SD) |
79 (10.1)) |
78 (8.6) |
0.859
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Glucose (mmol/l) mean (SD)
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4.9 (1.87) |
4.9 (0.34) |
0.496
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Cholesterol (mmol/l) mean (SD)
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4.6 (0.97) |
4.8 (1.00) |
0.417
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Triglycerides (mmol/l) mean (SD)
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1.04 (0.51) |
1.01 (0.61) |
0.374
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HDL (mmol/l) mean (SD)
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1.5 (0.49) |
1.7 (0.45) |
0.109
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LDL (mmol/l) mean (SD)
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2.5 (1.04) |
2.6 (1.06) |
0.954 |
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CCA IMT (mm) mean (SD)
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0.54 (0.10)
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0.49 (0.08)
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0.037
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Polyarticular n=27
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0.56 (0.11)
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0.48 (0.08)
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0.010
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JPSA n=4 |
0.48 (0.07) |
0.46 (0.02) |
0.289
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Systemic n=3 |
0.68 (0.05) |
0.51 (0.07) |
0.050
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Extended oligoarticular n=12
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0.51 (0.65) |
0.46 (0.42) |
0.054
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ERA n=5 |
0.46 (0.06) |
0.47 (0.09) |
0.806
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Disclosure:
E. Coulson,
None;
W. F. Ng,
None;
P. N. Platt,
None;
H. E. Foster,
None.
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