Premature atherosclerosis in Indian children with Juvenile Idiopathic Arthritis: A cross-sectional study

Background: Commonest cause of chronic arthritis in childhood is Juvenile Idiopathic Arthritis (JIA). Atherosclerosis is a chronic inflammation of the arteries. Both conditions are associated with high inflammatory cytokines. In adults with rheumatoid arthritis, atherosclerosis is a common cause of long term morbidity. Such data in children with JIA, especially from the Indian sub-continent, is lacking.

Objectives: To assess the risk of premature atherosclerosis in Indian children with JIA and study associated risk factors.

Method: A cross sectional study was carried out in the department of paediatric rheumatology of Vivekananda Institute of Medical Sciences from 2016 to 2019 involving 42 patients and 21 age and sex matched controls. Premature atherosclerosis was assessed in both cases and controls by measuring bilateral carotid intima thickness (CIMT) using high resolution ultrasonography (USG). For associated risk factors, serum lipid profile and homocysteine levels were measured. 

Results: JIA patients had higher CIMT compared to controls (0.5121mm vs 0.429mm, p<0.001). Among the subtypes, enthesitis related arthritis showed maximum increase in CIMT (0.5443mm). Considering risk factors, high density lipoprotein (HDL) was lower in cases compared to controls (47.17mg/dl vs 52.20mg/dl, p<0.02); homocysteine was more in cases compared to controls (20.76micromol/L vs 13.51micromol/L, p<0.01)

Conclusions:Our cohort of Indian children with JIA had a higher CIMT and higher associated risk factors compared to normal healthy children making them more prone to premature atherosclerosis.

Sri Lanka Journal of Child Health, 2021; 50: 32-37