Dynamics of blood lipid spectrum indicators in children with juvenile idiopathic arthritis taking into account basic therapy
Abstract
Summary. In patients with rheumatoid arthritis, the risk of cardiovascular disease associated with atherosclerosis, is significantly increased compared to the general population. Studies of a cohort of children and young adults indicated that the atherosclerotic process usually begins long before its clinical manifestation, and the degree of vascular changes is associated with both the number of risk factors and their severity. The use of basic drugs in rheumatic patients contributed to a decrease in cardiovascular mortality, mainly due to the elimination of the activity of the process, which itself is an inducer of the onset and progression of atherosclerosis. The aim of the study was to establish the nature of changes in the blood lipid spectrum in children with juvenile idiopathic arthritis under the influence of basic therapy. Object and methods. We examined 85 children (8–18 years old) with juvenile idiopathic arthritis and oligo- (61.5 %) and polyarticular (38.5 %) variants of the disease, twice, with an interval of one year. The parameters of the blood lipid spectrum were determined by the level of: total cholesterol, triglycerides, high density lipoproteins, atherogenic coefficient by the enzymatic method on an automatic biochemical analyzer-photometer A25, low lipoproteins and very low density cholesterol by calculation method. Research results. Analysis of the lipid profile in the group as a whole showed that patients with juvenile idiopathic arthritis had significantly higher total cholesterol values (p < 0.05), a tendency to an increase in the level of triglycerides, low lipoproteins and very low density cholesterol, which led to an increase in the atherogenic coefficient level. When analyzing the lipid spectrum of blood after a year, a tendency towards a decrease in the level of atherogenic and an increase in antiatherogenic fractions of the lipid spectrum with normalization of atherogenic coefficient was noted. In the group of patients receiving monotherapy with methotrexate, no significant changes in the lipid spectrum of blood were observed after one year. Against the background of combined basic therapy, the blood lipid spectrum normalizes, namely, a decrease in total cholesterol, an increase in high density lipoproteins of cholesterol, a decrease in the level of low density cholesterol (p < 0.05), triglycerides and very low density cholesterol and, as a consequence, significant decrease in atherogenic coefficient (p < 0.01). Conclusions. The dynamics of changes in blood lipid spectrum indicators in children with juvenile idiopathic arthritis confirms the need to use combined basic therapy not only to control the activity of main pathological process, but also to prevent the development of atherogenic dyslipoproteinemias.
Downloads
References
Zhang, J, Chen, L, Delzell, E, Muntner, P, Hillegass, WB., Safford, MM., Millan, IY, Crowson, CS. & Curtis, JR. The association between inflammatory markers, serum lipids and the risk of cardiovascular events in patients with rheumatoid arthritis. Ann Rheum Dis. 2014; 73 (7): 1301–1308. https://doi.org/10.1136/annrheumdis-2013-204715.
Skeoch S, Bruce IN. Atherosclerosis in rheumatoid arthritis: is it all about inflammation? Nat Rev Rheumatol. 2015; 11 (7): 390–400. https://doi.org/10.1038/nrrheum.2015.40.
Gabriel SE, Crowson CS. Risk factors for cardiovascular disease in rheumatoid arthritis. Curr Opin Rheumatol. 2012; 24 (2): 171–176. https://doi.org/10.1097/bor.0b013e32834ff2fd.
Coulson EJ, Ng W-F, Goff I & Foster H E. Cardiovascular risk in juvenile idiopathic arthritis. Rheumatology. 2013; 52 (7): 1163–1171. https://doi.org/10.1093/rheumatology/ket106.
Nadkarni A, You M, Resuehr H & Curtis J R. The risk for cardiovascular events associated with hyperlipidemia among patients with and without rheumatoid arthritis. J. Arthritis. 2015;4(40):178. https://doi.org/10.4172/2167-7921.1000178.
Erum U, Ahsan T. & Khowaja D. Lipid abnormalities in patients with rheumatoid arthritis. Pak J Med Sci. 2017; 33 (1): 227–230. https://doi.org/10.12669/pjms.331.11699.
Myasoedova E, Crowson CS, Kremers HM., Roger VL, Fitz-Gibbon PD, Therneau TM. & Gabriel SE. Lipid paradox in rheumatoid arthritis: the impact of serum lipid measures and systemic inflammation on the risk of cardiovascular disease. Ann Rheum Dis. 2011; 70 (3): 482–487. https://doi.org/10.1136/ard.2010.135871. [in Russian].
Amezaga UM, Suarez-Almazor ME. Lipid paradox in rheumatoid arthritis: changes with rheumatoid arthritis therapies. Curr Rheumatol Rep. 2012;14(5):428–437. https://doi.org/10.1007/s11926-012-0269-z.
Mackey RH, Kuller LH. & Moreland LW. Update on cardiovascular disease risk in patients with rheumatic diseases. Rheum Dis Clin North Am. 2018; 44 (3): 475–487. https://doi.org/10.1016/j.rdc.2018.03.006.
Södergren A, Karp K, Boman K, Eriksson C, Lundström E, Smedby T, Söderlund L, Rantapää-Dahlqvist S. & Wållberg-Jonsson, S. Atherosclerosis in early rheumatoid arthritis: very early endothelial activation and rapid progressi on of intima media thickness. Arthritis Res Ther. 2010; 12 (4): R158. https://dx.doi.org/10.1186%2Far3116.
Kovalenko VM, Lysenko HI, Khimion LV. & Harmish OO. Vplyv medykamentoznoi terapii na prohresuvannia subklinichnoho aterosklerozu ta rozvytok sudynnykh uskladnen u khvorykh na revmatoidnyi artryt [The effect of drug therapy on the progression of subclinical atherosclerosis and the development of vascular complications in patients with rheumatoid arthritis]. Ukrainian journal of rheumatology. 2012; 1 (47): 12–17. https://www.rheumatology.kiev.ua/wp/wp-content/uploads/2012/02/47_12-18.pdf?upload=. [in Ukrainian].
Berezhnyi VV, Romankevych IV. Yuvenilnyi revmatoidnyi artryt i ateroskleroz: novi pohliady na dva zakhvoriuvannia [Juvenile rheumatoid arthritis and atherosclerosis: new perspectives on two diseases]. Modern Pediatrics. 2011; 5 (39): 126–129. https://www.researchgate.net/publication/299487359_Uvenilnij_revmatoidnij_artrit_i_ateroskleroz_novi_pogladi_na_dva_zahvoruvanna. [in Ukrainian].
Robertson J, Peters MJ, McInnes IB. & Sattar N. Changes in lipid levels with inflammation and therapy in RA: a maturing paradigm. Nat Rev Rheumatol. 2013; 9: 513–523. https://doi.org/10.1038/nrrheum.2013.91.
Shepherd J, Cooper K, Harris P, Picot J. & Rose, M. The clinical effectiveness and cost-effectiveness of abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis: a systematic review and economic evaluation. Health Technol Assess. 2016; 20 (34): 1–222. https://doi.org/10.3310/hta20340.
Favalli EG, Pontikaki I, Becciolini A, Biggioggero M, Ughi N, Romano M, Crotti Ch, Gattinara M, Gerloni V, Marchesoni A. & Meroni PL. Real-life 10-year retention rate of first-line anti-TNF drugs for inflammatory arthritides in adult- and juvenile-onset populations: similarities and differences. Clin Rheumatol. 2017; 36 (8): 1747–1755. https://doi.org/10.1007/s10067-017-3712-8.
Rochette E, Bourdier P, Pereira B, Dore E, Birat A, Ratel S, Echaubard S, Duche P. & Merlin E. TNF blockade contributes to restore lipid oxidation during exercise in children with juvenile idiopathic arthritis. Рediatr Rheumatol Online J. 2019; 17 (1): 47. https://doi.org/10.1186/s12969-019-0354-1.
Verstegen RHJ, McMillan R, Feldman BM, Ito S. & Laxer, RM. Towards therapeutic drug monitoring of TNF inhibitors for children with juvenile idiopathic arthritis: a scoping review. Rheumatology (Oxford). 2020; 59 (2): 386–397. https://doi.org/10.1093/rheumatology/kez285.
Bag-Ozbek A, Giles, JT. Inflammation, adiposity and atherogenic dyslipidemia in rheumatoid arthritis: is there a paradoxical relationship? Curr Allergy Asthma Rep. 2015; 15 (2): 497. https://doi.org/10.1007/s11882-014-0497-6
The Journal of V. N. Karazin Kharkiv National University, series Medicine has following copyright terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work’s authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal’s published version of the work, with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.