Background/Purpose: Subclinical cardiac involvement was previously described in juvenile idiopathic arthritis (JIA) patients, however there is no data regarding echocardiography and cardiac biomarkers evaluations in JIA under biologic therapy. Therefore, the objectives of this study were to perform a global assessment of the long-term cardiac function in JIA patients under TNF blockage therapy.

Methods: Twenty–five polyarticular-course JIA patients pre-anti-TNF (etanercept or adalimumab) and 22 healthy controls underwent conventional/ tissue Doppler imaging echocardiography and cardiac biomarkers measurements [N-terminal pro-brain natriuretic peptide (NT-pro-BNP, cut-off≥125pg/mL for elevated values) and troponin T (cut-off>0.01μg/l for myocardial damage) by electrochemiluminescence immunoassay] at baseline (BL). Additionally, 21 JIA patients completed six evaluations during two consecutive years: BL, and 3, 6, 12, 18 and 24 months after anti-TNF treatment. Number of active joints, patient and physician visual analogue scales (VAS), Childhood Health Assessment Questionnaire (CHAQ), acute phase reactants [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)] were evaluated before and after anti-TNF therapy.

Results: JIA patients and controls were comparable regarding current age (11.6 vs. 9.2 years, p=0.15) and female gender (47 vs. 40%, p=1.0). The median of disease duration was 2.7 (0.4-9.9) years and 24 (96%) were under non-steroidal antiinflammatory drugs, 8 (32%) prednisone, 23 (92%) methotrexate, 5 (20%) leflunomide and 7 (28%) cyclosporine. At BL, on the conventional Doppler evaluation, there was a lower isovolumetric relaxation time of left ventricle in JIA patients compared to healthy controls [76 (56-89) vs. 81.5 (71-96)m/s, p=0.03]. On the tissue Doppler, all parameters were within normal values at BL, although ventricular septum velocity (VS) E’ wave (p=0.014) and VS S wave (p=0.03) were lower in JIA patients compared to healthy controls. Frequencies of elevated NT-pro-BNP levels were similar in JIA patients and controls (28 vs. 13.6%, p=0.3). Further comparison of JIA patients according to NT-pro-BNP levels at BL revealed that JIA patients with elevated levels of this cardiac biomarker had significantly more active joints (8 vs. 3, p=0.03) and higher ESR (55 vs. 29 mm/1^sthour, p=0.03) compared to those with normal levels. Positive correlations were observed between NT-pro-BNP levels and number of active joints (r=0.59, p=0.002) and between NT-pro-BNP levels and ESR (r=0.51, p=0.009). Prospective evaluation of 21 JIA patients revealed that none of the participants had symptoms of heart failure and all of them remained with normal ejection fraction, and no alteration was observed in other parameters of conventional and tissue Doppler imaging echocardiography. Only one patient had mild elevated levels of troponin T at 18 and 24 months evaluations.

Conclusion: Long-term TNF blockage safety was demonstrated in JIA patients in spite of the observed mild subclinical diastolic involvement. Elevated cardiac biomarker in these patients was associated with inflammatory parameters reinforcing the need for a careful interpretation of this finding in patients with active disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/long-term-evaluation-of-cardiac-function-in-juvenile-idiopathic-arthritis-under-anti-tumor-necrosis-factor-therapy/