Successful antirheumatic treatment improved the abnormal lipid levels associated with juvenile idiopathic arthritis in a small, prospective study of 58 children with the disease.
The children’s cholesterol levels and ratios – as well as C-reactive protein (CRP) levels – improved significantly over an 18-month period of treatment that controlled the disease.
"These results strongly suggest that lipid profiles are associated with disease activity and that effective antirheumatic therapy can reverse, at least partially, the adverse lipid profiles in patients with juvenile idiopathic arthritis," Dr. Chang-Ching Shen and colleagues wrote (Semin. Arthritis Rheum. 2013 Jan. 3 [doi:10.1016/j.semarthrit.2012.10.002]).
This is the first longitudinal study to report the association of disease activity with serum lipid profiles in juvenile idiopathic arthritis (JIA) patients, said Dr. Shen of the Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, and coauthors.
After 18 months of treatment with antirheumatic drugs, the investigators compared lipid profiles in 58 children treated for newly diagnosed JIA and stratified them into inactive (31) and active (27) disease status.
The patients’ mean age was 13 years, and the mean disease duration was about 5 months. More than 90% were taking NSAIDs. Methotrexate was the most common antirheumatic drug given (58% of inactive patients, 67% of active patients), followed by azathioprine (10% and 19%, respectively), sulfasalazine (16% and 11%), etanercept (13% and 11%), and prednisolone (52% and 63%).
Over the 18-month study, there were significant changes in lipid levels and atherogenic measures in the inactive disease group but not in the active disease group. High-density lipoprotein (HDL) cholesterol level increased by 5.5 mg/dL in the inactive group but decreased by 1.15 mg/dL in the active group. Total cholesterol increased 7.5 mg/dL in the inactive group and decreased 5.5 mg/dL in the active group. These changes correlated with changes in CRP, which decreased 14 mg/L in the inactive group and increased about 1 mg/L in the active group.
The investigators then compared the JIA patients with a matched set of 232 controls from the Nutrition and Health Survey in Taiwan, a national population-based study evaluating cardiovascular risk factors, including dyslipidemia, in Taiwanese people aged 4 years and older. The active disease group had significantly lower levels of HDL and total cholesterol than did control group patients. Levels in the control and inactive disease groups were similar. There were no between-group differences in the LDL/HDL ratio or in the ratio of total cholesterol/HDL cholesterol.
"Without using any lipid-modifying drugs, the aberrant lipid profiles were improved by a control of inflammatory status, which may in turn reduce the risk of cardiovascular disease in JIA," the investigators noted. "The results can provide a useful clue for further immunopathogenesis studies."
The currently available version of the report, a corrected proof, did not note study sponsors or any financial disclosures for any of the authors.