Juvenile idiopathic arthritis burden on the cardiovascular system: A single centre experience

Abstract

Abstract Background Adults with adolescent diagnosis of juvenile idiopathic arthritis (JIA), particularly those with the systemic phenotype, were found to have cardiovascular morbidities and earlier fatalities compared to the healthy controls. Objective to outline the possible early cardiovascular changes among patients with JIA. Patients and Methods: In this cross-sectional-controlled study with nested follow up, 57 JIA patients were enrolled and compared to age and sex matched 30 healthy subjects, at the period from September 2021 to September 2022. Patients with active JIA were followed up till remission. Assessment included echocardiography, tissue doppler to measure the carotid and aortic intima-media thickness (CIMT, AIMT), and the brachial artery flow mediated diameter (FMD), and serum endothelium (E)-selectin using ELISA technique. Results Serum levels of E-selectin were higher among JIA patients than in controls (p < 0.001), more increased during activity; whereas E-selectin level did not differ among categories of JIA. The estimated FMD, CIMT and AIMT did not show significant difference between patients and controls, however AIMT showed significant improvement with follow up of active patients and in patients treated with biological therapies. There was valvular affection and significant lower diameter of the left main coronary artery among patients with JIA compared to controls. There were no echocardiographic differences among the 3 categories of JIA, however, decrease in the mitral E/A and right ventricular myocardial performance index was found during follow up. Conclusion soluble E-selectin levels were higher among pediatric patients with JIA, particularly during activity denoting the possibility of early atherogenesis or subclinical cardiovascular disorder. Changes in AIMT during the follow up is another alarming sign. The reported changes were not related to the type of JIA rather than the activity status. Longitudinal cohorts are recommended for more precise evaluation of the cardiovascular burden of JIA.