Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Assessment for Early Cardiovascular Risk in Pediatric Rheumatic Disease
Tyrrell, Pascal N., Bradley, Timothy J., Ng, Lawrence, Slorach, Cameron, Sidhu, Sunita, Adeli, Khosrow, Beyene, Joseph
Adults with systemic lupus erythematosus (SLE) and rheumatoid arthritis are at increased risk of premature atherosclerosis irrespective of the presence of traditional cardiovascular risk factors. The aims of this study were to determine the prevalence of early vascular markers of atherosclerosis and the role of treatment and disease activity related factors in children with SLE, systemic juvenile idiopathic arthritis (SJIA) and juvenile dermatomyositis (JDM).
Subjects were enrolled into a prospective longitudinal study and assessed following the first visit. Drug therapy and disease activity were recorded. Fasting lipid and glycemic profiles were performed. Vascular assessment included carotid intima-media thickness (CIMT), flow-mediated dilatation (FMD), pulse wave velocity (PWV). These indices were converted to z-scores using normal population data from the same center. Between group comparisons were made using parametric methods.
Of the 137 children tested, SLE patients were older and more predominantly female (n=88, mean age: 15.4 ±2.5, 83% female) than JDM (n=28, 13.9 ±2.3, 50% female) and SJIA patients (n=21, 13.9 ±2.4, 57% female). Most children had a relatively healthy BMI (mean 22.4 ±4.6) and normal lipid profile of total cholesterol, LDL and HDL cholesterol, and triglyceride levels except for JDM patients who had elevated triglyceride (mean z-score: 1.8 ±2.9) and total cholesterol levels (mean z-score: 1.2 ±2.4). At the time of testing, subjects had been followed for a mean of 3.1 ±3.0 years and 91% were treated with corticosteroids (mean cumulative dose/kg: 0.2 ±0.3g). The following inflammatory markers were found to differ significantly for SLE compared to JDM and SJIA: higher ESR, lower complement levels C3 and C4, and lower albumin levels. CRP was found to be significantly higher in SJIA than SLE. Vascular function measures compared with controls: CIMT was lower in SJIA only (p=0.020); FMD was no different; and PWV was higher in SLE and JDM (both p<0.001). No difference between the three disease groups was found for CIMT, FMD or PWV when adjusting for sex, age, BMI, disease duration or cumulative corticosteroid dose.
Vascular markers of early atherosclerosis were found in children with rheumatic diseases but differed from controls according to the underlying disease. We found different disease-specific inflammatory factors in these patients which are likely to be important in determining risk of atherosclerosis and warrant further investigation.
To cite this abstract, please use the following information:
Tyrrell, Pascal N., Bradley, Timothy J., Ng, Lawrence, Slorach, Cameron, Sidhu, Sunita, Adeli, Khosrow, et al; Assessment for Early Cardiovascular Risk in Pediatric Rheumatic Disease [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1520