6.3 DETERMINING EARLY CARDIOVASCULAR RISK PROFILES IN PAEDIATRIC RHEUMATIC DISEASE

Abstract

Objectives: Increased cardiovascular risk in adults with systemic lupus erythematosus (SLE) and rheumatoid arthritis, not explained by exposure to traditional factors alone, have prompted investigation into the role of chronic inflammation. This study aimed to determine early cardiovascular risk profiles and their correlates in children with SLE, systemic juvenile inflammatory arthritis (SJIA) and juvenile dermatomyositis (JDM). Methods: Disease activity and drug therapy were recorded, fasting lipid, glycemic and inflammatory profiles performed, and vascular testing including carotid intima-media thickness (CIMT), flow-mediated dilatation (FMD) and pulse wave velocity (PWV). Data within groups were compared to normal controls and between groups using parametric methods. Results: Of 137 subjects, SLE (n=88) were older and more predominantly female than SJIA (n=21) and JDM (n=28) age 15.4±2.5 vs. 13.9±2.4 and 13.9±2.3 years, and female 83% vs. 57% and 50%, respectively. At testing, most had relatively healthy BMI, normal lipid and glycemic profiles and over mean follow-up 3.1±3.0 years, 91% received corticosteroids (mean cumulative dose/kg 0.24±0.30g). Higher ESR, but lower complement C3 and C4 and albumin were found in SLE vs. SJIA and JDM, while CRP was lower in SLE vs. SJIA. Lower CIMT in SJIA (p<0.05) and higher PWV in SLE and JDM (both p<0.001) were found vs. controls. No between group differences for CIMT, FMD or PWV were found, even when adjusting for sex, age, BMI, disease duration or cumulative corticosteroid dose. Conclusions: Early cardiovascular risk profiles vary in paediatric rheumatic diseases. Disease-specific inflammatory factors likely modify these cardiovascular risk profiles and warrant further investigation.