Subclinical atherosclerosis in Egyptian children with JIA: assessment of the risk factors

Background and aim of work: Juvenile idiopathic arthritis (JIA), is expected to accelerate the process of atherosclerosis. The aim of the current study is to identify possible risk factors of early development of subclinical atherosclerosis in children with JIA. Subjects and methods: This study included 42 JIA and 42 healthy controls. Traditional cardiovascular risk factors and inflammatory markers together with IMT (intima-media thickness), FMD (flow mediated dilation) of brachial arteries, and LVMi (left ventricle mass index) as surrogate markers of subclinical atherosclerosis were assessed and compared between patients and controls. Results: Patients with JIA had increased IMT and LVMi and decreased FMD% as compared to controls. The increased IMT, LVMi and brachial artery diameter and the decreased FMD% were associated with elevated BMI, elevated systolic blood pressure, and elevated inflammatory markers and with decreased HDL. Regression analysis revealed that for the increased IMT in patients who had JIA, BMI, SBP, hsCRP and TNF-? were the best predictors. Also, in the regression model the best predictors for FMD %, were the BMI, hsCRP and TNF-? while for LVMi, SBP was the only significant predictors in the regression model. Conclusion: Patients with JIA had impaired endothelial function, increased carotid IMT and increased LVMi which strongly confirm the evidence of presence of subclinical CV system changes that predispose to the development of atherosclerosis at this early age. This increased subclinical atherosclerosis depends mainly on increased BMI and the heightened inflammatory mediators.