Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Rheumatoid Arthritis (RA) is associated with a 50 % greater cardiovascular mortality rate than the general population, attributable to the increased prevalence of traditional risk factors and inflammatory molecules involved in coronary atherosclerosis. Many young people with Juvenile Idiopathic Arthritis (JIA) have their disease persisting into adulthood. Since persistent systemic inflammation is known to accelerate the atherosclerotic process, individuals with JIA and especially those with persistent inflammation may have a greater cardiovascular risk. This study was to assess the prevalence of traditional cardiovascular risk factors and carotid artery Intima-Media Thickness (cIMT) as a surrogate cardiovascular outcome. Additionally, potential biomarkers for predicting and monitoring of cardiovascular risks will be sought.
Methods: 51 adults with JIA (median age: 34.0 years, range: 18 – 63 years) were recruited from an adult continuity clinic along with 27 age- and gender- matched controls (median age 35.5 years, range: 18 – 62 years). JIA subtypes were defined by ILAR classification. After informed consent, cIMT was examined using B-mode ultrasound by one observer (EJC), and clinical data and blood samples were collected. cIMT images were analysed using the M’ath software package (Intelligence in Medical Technologies). Serum levels of potential cardiovascular risk biomarkers previously indentified in other adult inflammatory arthritides, such as systemic inflammatory and adhesion molecules, were quantified using ELISA kits (R&D Systems) or Cytometric Bead Arrays (BD Biosciences). Data were analysed using FCAP Array software.
Results: A significantly higher proportion of adults with JIA compared to controls had a pre-existing diagnosis of hypertension (12 % vs. 1 %, p = 0.029). Mean CRP and cIMT were significantly greater in patients than in controls (9.0 mg/ml vs. 5.6 mg/l, p=0.006, and 0.540 mm vs. 0.492 mm, p=0.039 respectively), especially among those with systemic JIA and RF+ polyarticular JIA. cIMT correlates with age (Pearson’s coefficient 0.67, p < 0.001). Serum levels of MPO, IL-12p70, IL-12/23p40, IL-4, IL-8, TNFα and IL-21 were significantly different between the adult JIA and control group. Among the JIA subgroups, the polyarticular JIA group has the highest level of LTA, while the oligoarticular JIA group has the highest level of CD40L. Extended oligoarticular JIA has higher levels of IP10 and IL-8. After correcting for age, hypertension and smoking, IL-12/23p40 (p < 0.01) and IL-12p70 (p = 0.035) remain independent predictors for the differences in cIMT between patients and controls.
Conclusion: Adults with JIA have increased cIMT, as well as serum levels of CRP and several pro-inflammatory cytokines compared to healthy controls. Furthermore, IL-12p70 and IL-12/23p40 could potentially be used as biomarkers for cardiovascular risk. IL-12 plays an important role in JIA pathogenesis, promoting Th1 response and inflammatory cytokines such as TNFα. It is noteworthy that MPO, which is linked with plaque development, thrombus formation and is a predictor of CVD in healthy individuals, is upregulated in adults with JIA.
Disclosure:
S. Crittenden,
None;
E. Coulson,
None;
V. Kunadian,
None;
W. F. Ng,
None;
H. E. Foster,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/elevated-cardiovascular-disease-burden-and-inflammatory-biomarker-levels-in-adults-with-juvenile-idiopathic-arthritis/