Background/Purpose: Several studies suggest an increased frequency of cardiovascular disease (CVD) in patients with rheumatoid arthritis, but little is known about CVD risk in patients with juvenile rheumatoid arthritis (JRA). The objective of this study was to evaluate the frequency of CVD and CVD risk factors in adults with a prior diagnosis of JRA compared to controls.

Methods: A retrospective, partly population-based cohort study was independently conducted utilizing patients at two major academic institutions (Cohorts 1 and 2).  Each institution employed a unique methodology to evaluate for the common endpoint of clinical CVD outcomes and risk factor development with comparison to control groups of similar age and sex. Cohort 1 was an inception cohort of residents of a geographically defined area who were diagnosed with JRA in 1960-1993. CVD and CVD risk factors were ascertained via medical record review and telephone survey for the subset of patients currently aged ≥30 years. Cohort 2 included patients diagnosed with JRA in 1980-1985 who participated in a clinical exam or completed a survey in 2011-2012 (i.e. 29 year follow-up).

Results: Among 41 patients with JRA and 28 controls in cohort 1, 3 patients (7%) had CVD, compared to 0 controls (p = 0.43).  Of these, 1 patient had CVD prior to age 30 with ages at time of CVD diagnosis ranging from 21-39 years. Types of CVD included 1 patient with venous and arterial thrombosis, 1 patient with coronary artery disease and myocardial infarction, and 1 patient with angina pectoris. Analysis for the presence of CVD risk factors in Cohort 1 demonstrated 15 patients (56%) with hyperlipidemia, compared to 0 controls (p = 0.019). Twenty patients (49%) were ever smokers, compared to 10 controls (36%) (p = 0.004). Other risk factors including hypertension, diabetes mellitus, and family history of CVD were elevated in the JRA cohort but did not obtain statistical significance. Among 170 JRA patients with 29 year follow-up and 91 controls in Cohort 2, 2 patients (2%) had CVD, compared to 0 controls (p = 0.29). Types of CVD included 1 patient with myocardial infarction and 1 patient with angina pectoris and myocardial infarction. Analysis for the presence of CVD risk factors in Cohort 2 demonstrated 14 patients (8%) with hypertension, compared to 2 controls (2%) (p = 0.049). Ninety patients (54%) were ever smokers, compared to 36 controls (40%) (p = 0.028). Other CVD risk factors measured and elevated in the JRA cohort included use of antilipemic medication, use of antihypertensive medication, and CVD in first degree relative, but statistical significance was not obtained. The presence of diabetes mellitus was equal in the JRA cohort and control group for Cohort 2.

Conclusion: Certain CVD risk factors including hyperlipidemia, hypertension, and smoking appear to be more common among patients with JRA than in age-matched controls. There may be a trend toward increased numbers of CVD events, and occurrence of CVD at younger ages in patients with JRA, although statistical significance was not demonstrated in this study. Continued longitudinal follow-up of these cohorts and larger population-based studies are needed to establish a definitive relationship between JRA and CVD.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/juvenile-rheumatoid-arthritis-and-future-risk-for-cardiovascular-disease-a-multicenter-population-based-study/