Arterial Stiffness in Adults with Lasting Juvenile Idiopathic Arthritis Linked to Prednisolone, Insulin Resistance

Arterial Stiffness in Adults with Lasting Juvenile Idiopathic Arthritis Linked to Prednisolone, Insulin Resistance

Adults with long-lasting juvenile idiopathic arthritis have altered arterial properties related to cardiovascular risk, such as arterial stiffness, mainly linked to daily prednisolone and insulin resistance, new findings show.

The study, “Arterial properties in adults with long-lasting active juvenile idiopathic arthritis compared to healthy controls,” was published in Pediatric Rheumatology.

Juvenile idiopathic arthritis is a chronic inflammatory rheumatic disease — any disease marked by inflammation and pain in the joints, muscles, or fibrous tissues. The symptoms of juvenile idiopathic arthritis start in childhood and persist into adulthood in about half the patients.

Adult-onset inflammatory arthritis has been shown to be related to arterial stiffness — an established predictor for cardiovascular disease characterized by physical stiffening of the large arteries. But research on the arterial properties and cardiovascular risk in those with long-lasting juvenile idiopathic arthritis has been limited.

Researchers from Norway’s Oslo University Hospital had previously reported an increased prevalence of hypertension and arterial stiffness in adults with long-lasting active juvenile idiopathic arthritis. However, the results were not compared to a patient control group. 

Now the team characterized systemic arterial properties in detail in patients compared to matched controls and tested for links among juvenile idiopathic arthritis, arterial properties, and cardiovascular risk factors.

Initially, over 100 juvenile idiopathic arthritis patients were referred to the Oslo University hospital between 1980 and 1985. Between May 2011 and March 2012, many of the participants returned for re-examination. In the end, 81 juvenile idiopathic arthritis patients (median age 38.6 years) with at least 15 years of active disease were examined over a span of around 29 years and compared to 41 healthy controls.

Juvenile idiopathic arthritis was classified according to the International League of Associations for Rheumatology criteria, and active disease was defined as the lack of remission if a patient was off anti-rheumatic medication.

Participants were questioned on their smoking habits and physical activity. Insulin resistance was derived from assessments of insulin and glucose.

The participants were examined by echocardiography and calibrated right common carotid artery tonometric pulse traces, for noninvasive estimates of pressure and blood flow from the aortic root. This allows researchers to estimate several arterial parameters.

In this long-term follow-up study, the researchers found that juvenile idiopathic arthritis patients with long-term active disease have altered systemic arterial properties when compared to controls. These altered arterial properties were mainly linked to years on daily prednisolone and insulin resistance, and to a certain extent, to the use of methotrexate.

“Our results suggest that adult patients with long-lasting active juvenile idiopathic arthritis had stiffer proximal aorta, and lower total arterial compliance but similar systemic resistance compared to matched controls from the general population,” researchers stated. “Years on daily prednisolone and insulin resistance were the most important correlates of altered arterial properties.”

The strengths of this study were that a well-defined group of participants was examined over a long-term period. However, the number of participants was relatively small, so more research is needed to know how relevant the findings are to patients with juvenile arthritis from different demographics.

“Whether our findings indicate that juvenile idiopathic arthritis patients should enter a regular blood pressure monitoring program needs to be determined in future longitudinal follow-up studies,” researchers stated.

“Larger prospective controlled studies are needed to identify determinants of altered arterial properties in juvenile arthritis patients. Our findings add to the previously reported association between prednisolone use and increased arterial stiffness in juvenile idiopathic arthritis patients from our cohort,” they concluded.

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