Zdorovʹe Rebenka (Sep 2020)
Dyslipidemia as a comorbid condition in children with juvenile idiopathic arthritis
Abstract
Background. The atherosclerotic process begins long before its clinical manifestation, and a study of a cohort of children and young adults shows that the degree of atherosclerotic changes in blood vessels is associated with both the number of risk factors and their intensity. For most children, the degree of vascular damage and the rate of progression are negligible. However, in the presence of a chronic inflammatory process, a classic example of which in children is juvenile idiopathic arthritis (JIA), subclinical signs of atherosclerosis are being detected in the early stages of the disease. Therefore, the aim of this study was to determine the relationship of lipid disorders with markers of inflammation and cardiovascular parameters in children with JIA. Materials and methods. Sixty-five children aged 8–18 years with JIA were examined in the process of dynamic observation. The immunological activity of the disease, the lipid spectrum of the blood, the functional state of the cardiovascular system were studied. Statistical processing of the material was performed using Statgraphics 16.0 Centurion. Results. Analysis of the lipid profile in the group as a whole showed that patients with JIA had significantly higher levels of total cholesterol (TC) (p < 0.05), a tendency towards an increase in the level of triglycerides (TG), low-density lipoproteins (LDL) and very low-density lipoproteins (VLDL), which led to an increase in the atherogenic index and the formation of atherogenic dyslipoproteinemia. A year later, the study showed a tendency towards a decrease in the level of atherogenic lipid fractions, an increase in antiatherogenic lipid fractions and normalization of atherogenic index. For in-depth analysis, groups with high levels of LDL, TG and low levels of high-density lipoproteins (HDL) were identified. In the group with a high level of LDL, in addition to an increase in the level of TC, a tendency towards an increase in TG and atherogenic index was revealed. During the examination a year later, on the background of pathogenetic therapy, there was a decrease in the level of TC and LDL (p < 0.05), a tendency towards a decrease in TG and an increase in HDL and, as a consequence, the normalization of atherogenic index. In the group with a high level of TG, an increase in the content of TC and a high level of LDL were registered. Upon examination one year later, the tendency towards an increase in TG remained (p < 0.05) and an increase in the level of VLDL (p < 0.05) was found. All patients in this subgroup had a seropositive antinuclear antibody (ANA) variant of JIA. In the subgroup of patients with low HDL levels, there was a quite high content of TG and the highest atherogenic index. In children of this subgroup, the polyarticular variant of JIA, seropositive for ANA, was detected. The study a year later showed that they had a significant increase in the level of HDL (p < 0.05), a tendency towards a decrease in LDL, VLDL, as well as the normalization of atherogenic index (p < 0.01). A subgroup of children receiving combination therapy with methotrexate (MTX) with an immunobiological drug was also identified. All patients in this group suffered from JIA for more than 3 years and had an ANA seropositive variant of arthritis. In the dynamics of observation, there was a normalization of the lipid spectrum of the blood, namely a decrease in TC, an increase in HDL, a decrease in LDL (p < 0.05), TG and VLDL and a significant decrease in atherogenic index (p < 0.01). This indicates the need for the use of combination basic therapy (MTX + immunobiological drug) in resistant variants of JIA. Conclusions. In children with JIA, on the background of active inflammatory process, a traditional model of atherogenic dyslipidemia was found. The prescription of basic therapy with MTX and MTX in combination with immunobiological drug leads to a decrease in inflammation and normalization of the lipid profile.
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