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Del Giudice E, Marcellino A, Hoxha S, Martucci V, Sanseviero M, Bloise S, De Maria SG, Leone MR, Ventriglia F, Lubrano R. Proteinuria and hematuria as early signs of renal involvement in juvenile idiopathic arthritis. Front Pediatr 2024; 12:1395961. [PMID: 38895193 PMCID: PMC11184124 DOI: 10.3389/fped.2024.1395961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Objectives To evaluate glomerular and tubular renal functions and analyze blood pressure in a cohort of pediatric patients with juvenile idiopathic arthritis (JIA). Methods A total of 40 pediatric patients, 20 (50%) with JIA and 20 (50%) healthy control subjects, were studied, and performed the renal function on 24-h collection and the 24-h ambulatory blood pressure monitoring (ABPM). Moreover, we compared renal function and blood pressure trends between the groups of JIA patients with different disease activities. Results No statistically significant differences were observed between patients with JIA and healthy children in terms of glomerular filtration rate (GFR), fractional excretion of sodium (FENa), tubular reabsorption of phosphate (TRP), and calcium-creatinine urine ratio (CaU/CrU). In contrast, we observed significantly higher values in JIA patients than in controls for the presence of hematuria (p < 0.0001) and proteinuria (p < 0.0001). Compared to the control group there were significantly higher values of hematuria and proteinuria/day in both groups of JIA patients with low disease activity (respectively, p = 0.0001 and p = 0.0002) and moderate disease activity (respectively p = 0.0001 and p = 0.0012). Systolic and diastolic dipping were significantly reduced in patients with JIA compared with healthy controls (p < 0.0001 and p < 0.0001, respectively). Conclusions Our study showed that children with JIA, already in the early stages of the disease, have higher values of hematuria and proteinuria, which are early warning signs of nephropathy. Therefore, detailed screening of renal function and pressure monitoring in patients are necessary to monitor their evolution over time.
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Affiliation(s)
- Emanuela Del Giudice
- Pediatrics and Neonatology Unit, Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Polo Pontino, Santa Maria Goretti Hospital, Latina, Italy
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2
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Zimba O, Gasparyan AY. Cardiovascular issues in rheumatic diseases. Clin Rheumatol 2023; 42:2535-2539. [PMID: 37269421 DOI: 10.1007/s10067-023-06656-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 05/15/2023] [Accepted: 05/28/2023] [Indexed: 06/05/2023]
Abstract
Cardiovascular disease is a major cause of morbidity and mortality in rheumatic diseases, particularly rheumatoid arthritis and systemic lupus erythematosus. Timely detection and monitoring of cardiovascular affections by advanced visualization techniques may improve outcomes across most rheumatic diseases. Although high-grade inflammation and (auto)immune pathways are well known for their negative effects on the heart and vasculature, cardiovascular risk estimation remains one of the unresolved critical issues in rheumatic diseases. The issue is complicated further in view of the latest reports on enhanced atherogenesis in the setting of fibromyalgia and osteoarthritis, where inflammation is seemingly not a major pathogenic factor. The intensity of systemic inflammation has been associated with major vascular events in some large cohort studies of inflammatory rheumatic diseases. Experts advocate for tight control of systemic inflammation and modifiable cardiovascular risk factors for reducing the overall risk of vascular events. Increasing patients' and specialists' knowledge and skills in cardiovascular monitoring and prevention is warranted to solve some of the cardiovascular issues in rheumatic diseases. Key Points • Cardiovascular issues are prevalent across all age groups of patients with rheumatic diseases. • Large cohort studies suggest that the intensity of systemic inflammation is a powerful predictor of vascular events in rheumatic diseases. • Reliable and widely tested tools for predicting vascular events in inflammatory rheumatic diseases are currently unavailable. • Empowering patients with rheumatic diseases and first-contact specialists with knowledge and skills to monitor and reduce cardiovascular risk factors' effects is a promising strategy.
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Affiliation(s)
- Olena Zimba
- Department of Clinical Rheumatology and Immunology, University Hospital in Krakow, Macieja Jakubowskiego 2, 30-688, Krakow, Poland.
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland.
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
| | - Armen Yuri Gasparyan
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, UK
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3
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Gruca M, Zamojska J, Niewiadomska-Jarosik K, Wosiak A, Stasiak A, Sikorska K, Stańczyk J, Smolewska E. Assessment of Cardiovascular Risk Factors in Patients with Juvenile Idiopathic Arthritis. Nutrients 2023; 15:nu15071700. [PMID: 37049540 PMCID: PMC10096608 DOI: 10.3390/nu15071700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Introduction: The aim of this study was to assess the exposure to cardiovascular disease (CVD) risk factors in patients with juvenile idiopathic arthritis (JIA). Intima–media complex thickness (IMT), selected metabolic parameters and health behaviors were assessed in the course of the study. Methods: The study included study group, which consisted of 45 patients with JIA and 37 healthy age- and sex-matched children in the control group. Analyses in both groups included anthropometric parameters, laboratory tests, IMT and a questionnaire on exposure to modifiable CVD risk factors. Results: The study confirmed that CVD risk factors were present in both groups of patients. Significantly more children with JIA had abnormal BMI (p = 0.006) compared to the control group. Children in the study group were more likely to consume fruit regularly (p = 0.021) and less likely to consume fast food (p = 0.011) and sweetened beverages (p = 0.042) than children in the control group. Only 1 patient with JIA met criteria for ideal cardiovascular health. Dietary habits were not associated with IMT values, BMI, presence of joint pain or biochemical parameters in the study group. Conclusions: Patients with JIA are exposed to cardiovascular risk factors equally to their healthy peers. Ideal cardiovascular health should be pursued in the pediatric population with particular attention paid to patients with chronic diseases (i.e., JIA). The application of carotid artery IMT measurement in the assessment of CVD risk requires studies on a larger group of patients.
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Affiliation(s)
- Marta Gruca
- Department of Pediatric Cardiology and Rheumatology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland
- Correspondence:
| | - Justyna Zamojska
- Department of Pediatric Cardiology and Rheumatology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland
| | | | - Agnieszka Wosiak
- Institute of Information Technology, Lodz University of Technology, 91-738 Lodz, Poland
| | - Aleksandra Stasiak
- Department of Pediatric Cardiology and Rheumatology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland
| | - Karolina Sikorska
- Paediatric Department, Independent Public Health Care Complex in Minsk Mazowiecki, Szpitalna 37, 05-300 Warsaw, Poland
| | - Jerzy Stańczyk
- Department of Pediatric Cardiology and Rheumatology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland
| | - Elżbieta Smolewska
- Department of Pediatric Cardiology and Rheumatology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland
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El Jalbout R, Levy E, Pastore Y, Jantchou P, Lapierre C, Dubois J. Current applications for measuring pediatric intima-media thickness. Pediatr Radiol 2022; 52:1627-1638. [PMID: 35013786 DOI: 10.1007/s00247-021-05241-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/20/2021] [Accepted: 10/31/2021] [Indexed: 10/19/2022]
Abstract
Intima-media thickness is a known subclinical radiologic marker of the early manifestations of atherosclerotic disease. It is the thickness of the vessel wall, most often the carotid artery. Intima-media thickness is measured on conventional US manually or automatically. Other measurement techniques include radiofrequency US. Because there is variation in its measurement, especially in children, several recommendations have been set to increase the measurement's validity and comparability among studies. Despite these recommendations, several pitfalls should be avoided, and quality control should be performed to avoid erroneous interpretation. This article summarizes current literature in relation to the clinical applications for intima-media thickness measurement in children with known risk factors such as obesity, liver steatosis, hypercholesterolemia, diabetes, hypertension, systemic inflammatory diseases, cancer survival, kidney and liver transplant, and sickle cell disease or beta thalassemia major. Most potential indications for intima-media thickness measurement remain in the research domain and should be interpreted combined with other markers. The objective of diagnosing an increased intima-media thickness is to start a multidisciplinary treatment approach to prevent disease progression and its sequelae in adulthood.
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Affiliation(s)
- Ramy El Jalbout
- Department of Radiology, Sainte-Justine Hospital and Research Center, University of Montreal, 3175 Chemin de la Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.
| | - Emile Levy
- Department of Gastroenterology, Sainte-Justine Hospital and Research Center, University of Montreal, 3175 Chemin de la Côte Sainte-Catherine, QC, H3T 1C5, Montreal, Canada
| | - Yves Pastore
- Department of Hematology/Oncology, Sainte-Justine Hospital and Research Center, University of Montreal, 3175 Chemin de la Côte Sainte-Catherine, QC, H3T 1C5, Montreal, Canada
| | - Prevost Jantchou
- Department of Gastroenterology, Sainte-Justine Hospital and Research Center, University of Montreal, 3175 Chemin de la Côte Sainte-Catherine, QC, H3T 1C5, Montreal, Canada
| | - Chantale Lapierre
- Department of Radiology, Sainte-Justine Hospital and Research Center, University of Montreal, 3175 Chemin de la Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Josée Dubois
- Department of Radiology, Sainte-Justine Hospital and Research Center, University of Montreal, 3175 Chemin de la Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
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Arsenaki E, Georgakopoulos P, Mitropoulou P, Koutli E, Thomas K, Charakida M, Georgiopoulos G. Cardiovascular Disease in Juvenile Idiopathic Arthritis. Curr Vasc Pharmacol 2020; 18:580-591. [DOI: 10.2174/1570161118666200408121307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 03/10/2020] [Accepted: 03/19/2020] [Indexed: 01/21/2023]
Abstract
Juvenile idiopathic arthritis (JIA), is a term used to describe a group of inflammatory disorders
beginning before the age of 16 years. Although for the majority of children remission is achieved
early, those with systemic or polyarticular form of the disease may present persistent symptoms in
adulthood. Considering that there is overlap in the pathogenesis of JIA with adult rheumatic diseases,
concerns have been raised as to whether JIA patients could be at increased cardiovascular (CV) risk in
the long-term. In this review, we summarize evidence for CV involvement in JIA and present data on
CV risk factors and surrogate markers of arterial disease. We also provide information on beneficial and
harmful CV effects of anti-inflammatory medications in the context of JIA and suggest strategies for
CV screening. Overall, patients with systemic forms of JIA demonstrate an adverse lipid profile and
early arterial changes relevant to accelerated arterial disease progression. Although there is paucity of
data on CV outcomes, we recommend a holistic approach in the management of JIA patients, which
includes CV risk factor monitoring and lifestyle modification as well as use, when necessary, of antiinflammatory
therapies with documented CV safety.
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Affiliation(s)
| | - Panagiotis Georgakopoulos
- National Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Evangelia Koutli
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, United Kingdom
| | - Konstantinos Thomas
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marietta Charakida
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
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Early-onset subclinical cardiovascular damage assessed by non-invasive methods in children with Juvenile Idiopathic Arthritis: analytical cross-sectional study. Rheumatol Int 2020; 41:423-429. [PMID: 32857280 DOI: 10.1007/s00296-020-04689-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
Chronic inflammation starting early in life and continuing into adulthood may predispose children with Juvenile Idiopathic Arthritis (JIA) to cardiovascular (CV) complications. To compare non-invasive CV risk markers- left ventricular mass index (LVMi), brachial artery flow mediated dilatation (FMD) and carotid artery intima-media thickness (CIMT) between patients with JIA and healthy controls. Measurements of LVMi, CIMT and FMD and lipid profile were compared between 4 and 18 year old 81 patients with JIA and 78 age and sex matched healthy controls. Among 81, 20 had systemic onset, 19 enthesitis related arthritis, 9 polyarticular rheumatoid factor (RF) + ve, 19 polyarticular RF -ve, 11 oligo-articular, and 3 un-differentiated JIA. FMD was significantly lower (p < 0.001), CIMT and LVMi significantly higher in patients (p ≤ 0.001). CIMT showed positive correlation with blood pressure (p = 0.001), disease duration (p ≤ 0.001) and negative correlation with high density lipoprotein (HDL) (p ≤ 0.001). FMD correlated positively with HDL (p = 0.006) and negatively with disease duration (p ≤ 0.001). CIMT (p = 0.017) and FMD (p = 0.04) were significantly worse in active than inactive disease. Children with JIA have worse lipid profile, increased LVMi, CIMT, and reduced brachial artery FMD, suggestive of early cardiovascular dysfunction.
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7
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Aranda-Valera IC, Arias de la Rosa I, Roldán-Molina R, Ábalos-Aguilera MDC, Torres-Granados C, Patiño-Trives A, Luque-Tevar M, Ibáñez-Costa A, Guzmán-Ruiz R, Malagón MDM, Escudero-Contreras A, López-Pedrera C, Collantes-Estévez E, Barbarroja N. Subclinical cardiovascular risk signs in adults with juvenile idiopathic arthritis in sustained remission. Pediatr Rheumatol Online J 2020; 18:59. [PMID: 32665015 PMCID: PMC7362625 DOI: 10.1186/s12969-020-00448-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 07/03/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Juvenile Idiopathic Arthritis (JIA) is one of the most common chronic diseases of childhood that often persists into adulthood and can result in significant long-term morbidity. As a long lasting chronic inflammatory disease, concern has been raised regarding the risk of premature development of cardiovascular disease (CVD) in JIA. This study aims to determine whether adults with JIA in clinical remission display clinical and subclinical signs of CVD risk: inflammatory mediators, adipokines, endothelial dysfunction and oxidative stress markers. METHODS This is a cross-sectional study including 25 patients diagnosed with JIA according to the International League of Associations for Rheumatology criteria (ILAR 2001) and 25 age- and sex-matched controls. Remission was determined by JADAS10 < 1 and according to Wallace criteria. The presence of traditional CVD risk factors was analyzed. An extensive clinical analysis including body mass index (BMI), lipid profile, homeostatic model assessment - insulin resistance (HOMA-IR) and arterial blood pressure was performed. Intima media thickness of the common carotid artery (CIMT) was measured as a marker of subclinical atherosclerosis. Several proinflammatory cytokines, molecules involved in the endothelial dysfunction, oxidative stress and adipokines were quantified on serum by ELISA and on peripheral blood mononuclear cells (PBMCs) by RT-PCR. In vitro studies were carried out in healthy PBMCs, adipocytes and endothelial cells which were treated with serum from JIA patients under sustained remission. RESULTS Mean duration of the disease was 13.47 ± 5.47 years. Mean age was 25.11 ± 7.21. Time in remission was 3.52 ± 3.33 years. Patients were in remission with no treatment (40%) and with treatments (60%). CVD risk factors and CIMT were similar in JIA patients and controls. However, cholesterol levels were significantly elevated in JIA patients. Levels of adipocytokines, oxidative stress and endothelial activation markers were elevated in serum and PBMCs from JIA patients. Serum of those JIA patients induced the activation of adipocytes, endothelial cells and healthy PBMCs. CONCLUSIONS JIA adult patients in remission have subclinical signs of inflammation and CVD risk, showed by an increase in the levels of inflammatory cytokines, endothelial activation and oxidative stress markers and adipokines, molecules closely involved in the alteration of the vascular system.
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Affiliation(s)
| | - Iván Arias de la Rosa
- grid.428865.50000 0004 0445 6160Rheumatology Department, IMIBIC/Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain ,grid.428865.50000 0004 0445 6160Medicine Department, University of Cordoba/IMIBIC/Reina Sofía University Hospital, Cordoba, Spain
| | - Rosa Roldán-Molina
- grid.428865.50000 0004 0445 6160Rheumatology Department, IMIBIC/Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain
| | - María del Carmen Ábalos-Aguilera
- grid.428865.50000 0004 0445 6160Rheumatology Department, IMIBIC/Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain
| | - Carmen Torres-Granados
- grid.428865.50000 0004 0445 6160Rheumatology Department, IMIBIC/Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain
| | - Alejandra Patiño-Trives
- grid.428865.50000 0004 0445 6160Rheumatology Department, IMIBIC/Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain
| | - María Luque-Tevar
- grid.428865.50000 0004 0445 6160Rheumatology Department, IMIBIC/Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain
| | - Alejandro Ibáñez-Costa
- grid.428865.50000 0004 0445 6160Rheumatology Department, IMIBIC/Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain
| | - Rocío Guzmán-Ruiz
- grid.411901.c0000 0001 2183 9102Department of Cell Biology, Physiology and Immunology, IMIBIC, Reina Sofía University Hospital, University of Córdoba, Cordoba, Spain
| | - María del Mar Malagón
- grid.411901.c0000 0001 2183 9102Department of Cell Biology, Physiology and Immunology, IMIBIC, Reina Sofía University Hospital, University of Córdoba, Cordoba, Spain ,grid.413448.e0000 0000 9314 1427CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Alejandro Escudero-Contreras
- grid.428865.50000 0004 0445 6160Rheumatology Department, IMIBIC/Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain
| | - Chary López-Pedrera
- grid.428865.50000 0004 0445 6160Rheumatology Department, IMIBIC/Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain
| | - Eduardo Collantes-Estévez
- grid.428865.50000 0004 0445 6160Rheumatology Department, IMIBIC/Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain ,grid.428865.50000 0004 0445 6160Medicine Department, University of Cordoba/IMIBIC/Reina Sofía University Hospital, Cordoba, Spain
| | - Nuria Barbarroja
- Rheumatology Department, IMIBIC/Reina Sofía University Hospital/University of Cordoba, Cordoba, Spain. .,Medicine Department, University of Cordoba/IMIBIC/Reina Sofía University Hospital, Cordoba, Spain. .,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
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Pacifico L, Perla FM, Tromba L, Carbotta G, Lavorato M, Pierimarchi P, Chiesa C. Carotid Extra-Media Thickness in Children: Relationships With Cardiometabolic Risk Factors and Endothelial Function. Front Endocrinol (Lausanne) 2020; 11:574216. [PMID: 33071981 PMCID: PMC7541844 DOI: 10.3389/fendo.2020.574216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/25/2020] [Indexed: 12/26/2022] Open
Abstract
Background: Emerging evidence suggests that structural adventitial modifications and perivascular adipose tissue (PAT) may have a role in early atherogenesis. In a cohort of children and adolescents, we explored (1) the association of carotid extra-media thickness (cEMT), an ultrasound measure whose main determinants are arterial adventitia and PAT, with obesity and its cardiometabolic complications; and (2) the interplay between cEMT and endothelial function. Methods: The study participants included 286 youths (age, 6-16 years; 154 boys, and 132 girls). Anthropometric and laboratory parameters, liver ultrasound, vascular structure measures [cEMT and carotid intima-media thickness (cIMT)], endothelial function [brachial artery flow-mediated dilation (FMD)] were obtained in all subjects. Non-alcoholic fatty liver disease (NAFLD) was diagnosed in the presence of hepatic fat on ultrasonography, in the absence of other causes of liver disease. Diagnosis of metabolic syndrome (MetS) was established on the basis of three or more of the following cardiovascular disease (CVD) risk variables: abdominal obesity, high triglycerides, low high-density lipoprotein cholesterol, elevated blood pressure (BP), and impaired fasting glucose. Results: cEMT demonstrated significant associations with body-mass index (BMI) and waist circumference (WC), BP, insulin resistance, NAFLD, and inflammation. No association was found between cEMT and lipid values, and between cEMT and MetS. A stepwise multivariate linear regression analysis indicated that WC (β coefficient, 0.35; P < 0.0001) was the only determinant of cEMT, independently of other major cardiometabolic risk factors. Further adjustment for cIMT did not significantly alter this association. FMD was correlated to age, Tanner stage, total and abdominal obesity, BP, NAFLD, and cEMT. The association between FMD and cEMT was independent of age, sex, Tanner stage, WC, and BMI (β coefficient, -0.14; P = 0.027). After controlling for CVD risk factors and basal brachial artery diameter, cEMT remained associated with FMD (β coefficient, -0.11; P = 0.049). Conclusions: In youths, cEMT is associated with abdominal fat, a well-established body fat depot with important implications for cardiovascular diseases. Furthermore, cEMT is related to FMD, suggesting that arterial adventitia and PAT may be involved in the early changes in endothelial function.
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Affiliation(s)
- Lucia Pacifico
- Department of Mother and Child Health, Sapienza University of Rome, Rome, Italy
- *Correspondence: Lucia Pacifico
| | | | - Luciana Tromba
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Giovanni Carbotta
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Michela Lavorato
- Department of Mother and Child Health, Sapienza University of Rome, Rome, Italy
| | | | - Claudio Chiesa
- Institute of Translational Pharmacology, National Research Council, Rome, Italy
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9
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Muñiz Fontán M, Oulego Erroz I, Revilla Orias D, Muñoz Lozón A, Rodriguez Núñez A, Lurbe I Ferrer E. Thoracic Aortic Intima-Media Thickness in Preschool Children Born Small for Gestational Age. J Pediatr 2019; 208:81-88.e2. [PMID: 30732998 DOI: 10.1016/j.jpeds.2018.12.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 12/16/2018] [Accepted: 12/17/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess thoracic aortic intima-media thickness (aIMT) as a marker of thoracic aortic remodeling in children born small for gestational age (SGA). STUDY DESIGN We assessed thoracic aIMT, carotid intima-media thickness (cIMT), and pulse wave velocity (PWV) in 239 patients (117 SGA; 122 appropriate for gestational age controls) age 6-8 years. Each SGA participant was matched 1:1 based on sex, gestational age, and birth date. Thoracic aIMT was determined by 2-dimensional transthoracic echocardiography. RESULTS SGA children showed a significant increase in both aIMT (0.89 mm [0.12] vs 0.79 mm [0.11], P < .001) and cIMT (.50 mm [0.05] vs 0.49 mm [0.04], P < .001) compared with appropriate for gestational age controls, but the magnitude of the difference in aIMT was greater than that in cIMT (standardized difference of the means: +84% vs +27%). aIMT was linearly correlated with aortic arch PWV as measured by echocardiography (r = 0.211, P < .001) but not with carotid-femoral PWV (r = 0.113, P = .111). Born SGA was independently associated with increased aIMT after controlling for perinatal, anthropometric, and biochemical determinants in linear regression models. CONCLUSIONS SGA children exhibit increased thoracic aIMT and aortic arch PWV in early childhood that may suggest the presence of structural changes in the thoracic aorta wall architecture. Measurement of ascending aIMT by transthoracic echocardiography is feasible and reproducible and may be a useful marker of vascular disease.
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Affiliation(s)
- Manoel Muñiz Fontán
- Department of Pediatrics, Complejo Asistencial Universitario de León, León, Spain.
| | - Ignacio Oulego Erroz
- Department of Pediatrics, Clinical Division for Cardiology, Complejo Asistencial Universitario de León, León, Spain
| | | | - Ana Muñoz Lozón
- Department of Pediatrics, Complejo Asistencial Universitario de León, León, Spain
| | - Antonio Rodriguez Núñez
- Department of Pediatrics, Hospital Clínico Universitario Santiago de Compostela, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Empar Lurbe I Ferrer
- Cardiovascular Risk Unit, Consorcio Hospital General Universitario, University of Valencia, Valencia, Spain
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10
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Mistry RR, Patro P, Agarwal V, Misra DP. Enthesitis-related arthritis: current perspectives. Open Access Rheumatol 2019; 11:19-31. [PMID: 30774484 PMCID: PMC6354696 DOI: 10.2147/oarrr.s163677] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In this narrative review, we overview the recent literature on enthesitis-related arthritis (ERA). For the purpose of our review, we searched Scopus for recent articles on this subject from 2013 onward, including some classic older articles for perspective. ERA is a juvenile idiopathic arthritis (JIA) subtype more common in males, associated in a majority with human leucocyte antigen B27. Such children generally present with asymmetric oligoarthritis or polyarthritis, predominantly of lower limb joints, associated with enthesitis or sacroiliitis. While diagnosis remains clinical, ultrasound is being increasingly used to detect subclinical enthesitis and for guiding entheseal site injections. Spine MRI can help detect sacroiliitis, inflammatory spinal changes, and pelvic sites of enthesitis in such patients. The recent juvenile spondyloarthropathy disease activity index recognizes the key clinical features of ERA, viz enthesitis and inflammatory back pain, which other disease activity indices used in JIA did not include. Management includes NSAIDs with physical therapy. Conventional disease-modifying agents like sulfasalazine and methotrexate may be used to minimize duration of NSAID use and in those with high inflammatory burden. In patients refractory to these drugs, biologics such as antitumor necrosis factor alpha agents have proven useful, based on evidences from randomized controlled trials and retrospective registry analyses. Factors predicting a poorer outcome in such children include hip or ankle involvement or restricted spinal mobility. Considering that children with ERA have overall poorer long-term outcomes than other subtypes of JIA, there is a need to further optimize therapeutic strategies for such patients.
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Affiliation(s)
- Rutviz Rajendra Mistry
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India,
| | - Pallavi Patro
- Department of Pharmacology, Sriram Chandra Bhanja (SCB) Medical College, Cuttack, India
| | - Vikas Agarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India,
| | - Durga Prasanna Misra
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India,
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