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Kern C, Ortiz C, Johanis M, Ye M, Tahir P, Mulick A, Allen IE, McCulloch CE, Langan SM, Abuabara K. Atopic Dermatitis and Cardiovascular Risk in Pediatric Patients: A Systematic Review and Meta-Analysis. J Invest Dermatol 2024; 144:1038-1047.e16. [PMID: 37972725 PMCID: PMC11163969 DOI: 10.1016/j.jid.2023.09.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/23/2023] [Accepted: 09/28/2023] [Indexed: 11/19/2023]
Abstract
Cardiovascular guidelines recommend early screening and preventative treatment for children with chronic inflammatory diseases. Atopic dermatitis (AD) is associated with cardiovascular risk in adults, but data in children are limited. We systematically searched for studies that examined the association between childhood AD and cardiovascular risk factors and outcomes. Data from 10 publications, including 577,148 individuals, revealed an association between AD and ischemic heart disease (n = 3, OR = 1.68, 95% confidence interval [CI] = 1.29-2.19) and diabetes (n = 4, OR = 1.31, 95% CI = 1.12-1.53), but this did not persist among studies that adjusted for potential confounders (n = 2, OR = 0.98, 95% CI = 0.35-2.75). Similarly, there was an association with lipid disorders but not across the entire population distribution (n = 7, OR = 1.24, 95% CI = 1.13-1.36, 95% prediction interval = 0.95-1.61). AD was not associated with hypertension (n = 5, OR = 1.15, 95% CI = 0.98-1.34, 95% prediction interval = 0.81-1.62) or stroke (n = 2, OR = 1.24, 95% CI = 0.94-1.62). Studies lacked detail on AD severity and important confounders such as body mass index, and the certainty of evidence was very low to low on the basis of GRADE (Grading of Recommendations, Assessment, Development and Evaluation) assessments. Currently, data do not support a clinically meaningful increase in cardiovascular risk for children with AD.
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Affiliation(s)
- Chloe Kern
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Camila Ortiz
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York, USA
| | - Michael Johanis
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Morgan Ye
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Peggy Tahir
- University of California San Francisco Library, University of California San Francisco, San Francisco, California, USA
| | - Amy Mulick
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Isabel E Allen
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Charles E McCulloch
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Katrina Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA.
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2
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Bertoni C, Mazzocchi A, Leone L, Agostoni C, Filocamo G. Cardiovascular risk and inflammation in a population with autoimmune diseases: a narrative review. Front Immunol 2024; 15:1380372. [PMID: 38605945 PMCID: PMC11006973 DOI: 10.3389/fimmu.2024.1380372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Abstract
Juvenile Systemic Connective Tissue Diseases (JSCTD) are a heterogeneous group of chronic autoimmune diseases, associated with dyslipidemia and increased cardiovascular risk are related. Studies from the last 10 years, from 2013 to 2022, on lipid profiles in JSCTD were collected. Different studies on lipid profiles in children affected by JSCTD were selected, because the aim is to analyze the cardiovascular risk and the possibility of atherosclerosis in these patients in whom, sometimes, corticosteroid therapies and immunosuppressants increase the state of dyslipidemia. Several studies have shown that autoimmune diseases with an inflammatory substrate also share abnormalities in lipid profile and increased cardiovascular risk. Specifically, associations have been found between Juvenile Systemic Connective Tissue Diseases and elevated triglycerides, TC-C (Total Cholesterol), LDL-C (Low-Density Lipoprotein), low HDL-C (High-Density Lipoprotein), and increased risk of developing diseases such as myocardial infarction, peripheral vascular disease, pulmonary and arterial hypertension, and atrial fibrillation. Supplementation with alpha-linolenic acid (ALA) on the other hand has also been analyzed with positive results in reducing inflammatory parameters, such as IL-6 (Interleukin-6), CRP (C-reactive protein), and fasting glucose, in subjects with dyslipidemia. These observations suggest that supplementation with ALA, an omega-3 precursor, may positively modulate both the inflammatory status and dyslipidemic conditions in patients with autoimmune disorders.
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Affiliation(s)
- Camilla Bertoni
- Department of Veterinary Sciences for Health, Animal Production and Food Safety, University of Milan, Milan, Italy
| | - Alessandra Mazzocchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Ludovica Leone
- Pediatric Area, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Pediatric Area, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Filocamo
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Pediatric Area, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Grande Ospedale Maggiore Policlinico, Milan, Italy
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3
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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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Thomas KN, Aggarwal A. Childhood rheumatic diseases: bites not only the joint, but also the heart. Clin Rheumatol 2023; 42:2703-2715. [PMID: 37160484 PMCID: PMC10169151 DOI: 10.1007/s10067-023-06621-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/11/2023]
Abstract
Cardiovascular involvement in juvenile rheumatic diseases is the primary manifestation in paediatric vasculitis and a major organ manifestation in paediatric connective tissue diseases. Though coronary vasculitis is the prototypical manifestation of Kawasaki disease, it can also be seen in patients with polyarteritis nodosa. Pericarditis is the most common manifestation seen in juvenile rheumatic diseases like systemic onset JIA, and lupus. Cardiac tamponade, valvular insufficiency, aortic root dilatation and arrhythmias are seen rarely. Cardiac involvement is often recognized late in children. The development of cardiac disease in juvenile systemic sclerosis is associated with a poor outcome. In long term, childhood onset of rheumatic diseases predisposes to diastolic dysfunction and premature atherosclerosis during adulthood. Key Points • Pericarditis is the most common cardiac manifestation in SLE and can lead to tamponade. • Conduction defects are common in juvenile mixed connective tissue disease and systemic sclerosis. • Pulmonary hypertension is a significant contributor to mortality in juvenile systemic sclerosis. • In Kawasaki disease, early treatment can reduce risk of coronary artery aneurysms.
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Affiliation(s)
- Koshy Nithin Thomas
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Amita Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
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Obesity as a comorbidity in children and adolescents with autoimmune rheumatic diseases. Rheumatol Int 2023; 43:209-219. [PMID: 36394598 DOI: 10.1007/s00296-022-05238-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/21/2022] [Indexed: 11/18/2022]
Abstract
Childhood obesity is the public health issue with alarming rates recorded throughout developed world and an important modifiable health risk for developing various chronic diseases, with childhood-onset autoimmune rheumatic diseases among them also. The aim of this article was to summarize epidemiological, pathophysiological and clinical implication of obesity on juvenile idiopathic arthritis (JIA), childhood-onset systemic lupus erythematosus (cSLE), juvenile dermatomyositis (JDM), IgA vasculitis (IgAV) and Kawasaki disease (KD). We reviewed PubMed database and selected 74 relevant articles. Epidemiological data of obesity among children with autoimmune rheumatic diseases indicate an increased prevalence of it. Pathophysiological link between obesity, humoral adipokines and cytokines released from fat tissue and childhood-onset autoimmune rheumatic diseases is complex and still not entirely clear. From the clinical point of view, obesity was not associated with disease activity in JIA and cSLE, but proved to contribute on functional impairment in both diseases and affect poor treatment response in JIA patients. Early atherosclerosis and cardiovascular disease (CVD) development in obese children and adolescents with JIA, cSLE and JDM are certainly important obesity-related complications. Understanding how obesity affects children and adolescents with autoimmune rheumatic diseases may encourage clinicians to consider taking better preventive strategies in this population to improve their long-term outcome.
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Grammatikopoulou MG, Gkiouras K, Syrmou V, Vassilakou T, Simopoulou T, Katsiari CG, Goulis DG, Bogdanos DP. Nutritional Aspects of Juvenile Idiopathic Arthritis: An A to Z for Dietitians. CHILDREN (BASEL, SWITZERLAND) 2023; 10:203. [PMID: 36832332 PMCID: PMC9955348 DOI: 10.3390/children10020203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023]
Abstract
Juvenile idiopathic arthritis (JIA) represents a chronic, autoimmune, rheumatic musculoskeletal disease with a diagnosis before 16 years of age. Chronic arthritis is a common manifestation in all JIA subtypes. The nature of JIA, in combination to its therapy often results in the development of nutrition-, gastrointestinal (GI)- or metabolic-related issues. The most-common therapy-related nutritional issues involve methotrexate (MTX) and glucocorticosteroids (GCC) adverse events. MTX is a folic acid antagonist, thus supplementation with folic acid in required for improving GI side effects and correcting low serum levels. On the other hand, long-term GCC administration is often associated with hyperglycemia, insulin resistance and growth delay. This relationship is further aggravated when more joints are affected and greater doses of GCC are being administered. Apart from stature, body mass index z-scores are also suboptimal in JIA. Other signs of malnutrition include decreased phase angle and muscle mass, especially among patients with polyarthritis JIA. Evidence also points to the existence of an inverse relationship between disease activity and overweight/obesity. Specific dietary patterns, including the anti-inflammatory diet, might confer improvements in selected JIA outcomes, but the level of available research is yet insufficient to draw safe conclusions. The majority of patients exhibit suboptimal vitamin D status; hence, supplementation is recommended. Collectively, the evidence indicates that, due to the age of onset and the complexity of the disease, along with its pharmacotherapy, children with JIA are prone to the development of several nutritional problems, warranting expert monitoring. Vitamin deficiencies, oral and GI-problems limiting dietary intake, faltering growth, overweight and obesity, physical inactivity, or impaired bone health are among the many nutritional issues in JIA requiring dietitian support.
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Affiliation(s)
- Maria G. Grammatikopoulou
- Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Konstantinos Gkiouras
- Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Vasiliki Syrmou
- Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Tonia Vassilakou
- Department of Public Health Policy, School of Public Health, University of West Attica, 196 Alexandras Avenue, GR-11521 Athens, Greece
| | - Theodora Simopoulou
- Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Chistina G. Katsiari
- Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 76 Agiou Pavlou Str., Pavlos Melas, GR-56429 Thessaloniki, Greece
| | - Dimitrios P. Bogdanos
- Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
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7
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Schipper HS, de Ferranti S. Atherosclerotic Cardiovascular Risk as an Emerging Priority in Pediatrics. Pediatrics 2022; 150:189711. [PMID: 36217888 DOI: 10.1542/peds.2022-057956] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 12/05/2022] Open
Abstract
Over the last decades, childhood and adolescence have emerged as an important window of opportunity to prevent atherosclerotic cardiovascular disease (ASCVD) later in life. Here, we discuss the underlying advances in the field. First, atherosclerosis development starts as early as childhood. Atherogenesis initiates in the iliac arteries and abdominal aorta and subsequently develops in higher regions of the arterial tree, as has been demonstrated in nonhuman primate studies and human autopsy studies. Obesity, hypertension, hyperlipidemia, and hyperglycemia at a young age can accelerate atherogenesis. Children and adolescents with obesity have a relative risk of ∼ 2.5 for ASCVD mortality later in life, compared to peers with a normal weight. Conversely, early prevention improves long-term cardiovascular outcomes. Second, we review disease-associated factors that add to the traditional risk factors. Various pediatric disorders carry similar or even higher risks of ASCVD than obesity, including chronic inflammatory disorders, organ transplant recipients, familial hypercholesterolemia, endocrine disorders, childhood cancer survivors, chronic kidney diseases, congenital heart diseases, and premature birth, especially after fetal growth restriction. The involved disease-associated factors that fuel atherogenesis are diverse and include inflammation, vascular, and endothelial factors. The diverse and growing list of pediatric groups at risk underscores that cardiovascular risk management has solidly entered the realm of general pediatrics. In a second review in this series, we will, therefore, focus on recent advances in cardiovascular risk assessment and management and their implications for pediatric practice.
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Affiliation(s)
- Henk S Schipper
- Department of Pediatric Cardiology.,Center for Translational Immunology, Wilhelmina Children's Hospital and University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sarah de Ferranti
- Department of Cardiology, Boston Children's Hospital and Harvard University Medical School, Boston, Massachusetts
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8
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Wieringa WG, van Berkel RJ, Los LI, Lelieveld OTHM, Armbrust W. Physical and Psychosocial Health in Pediatric Uveitis Patients. Ocul Immunol Inflamm 2022; 30:1692-1700. [PMID: 34228595 DOI: 10.1080/09273948.2021.1934484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND To investigate the possible associations between childhood noninfectious uveitis and cardio-respiratory fitness, physical activity, health related quality of life and fatigue. METHODS Cross-sectional analysis of 23 patients with noninfectious uveitis, aged 8-18 years. BMI, exercise capacity, muscle strength and physical activity were measured. Health-related quality of life and fatigue were assessed. The results were compared to standardized values for age matched healthy children. RESULTS Twenty-three patients were included. Children with uveitis had a higher bodyweight and body mass index. Children with uveitis had lower cardio-respiratory fitness and they were less physically active, but they experienced a normal quality of life and normal fatigue. Parents of children with uveitis reported a lower quality of life and more fatigue for their children than parents of healthy children. CONCLUSION Our study indicates that children with noninfectious uveitis are at risk of developing lower physical and psychosocial health.
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Affiliation(s)
- Wietse G Wieringa
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Rosanne J van Berkel
- Department of Children's Rheumatology and Immunology, Beatrix Children's Hospital, Groningen, RB, The Netherlands
| | - Leonoor I Los
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,W.J. Kolff Institute, Graduate School of Medical Sciences, University of Groningen, Groningen, AV, The Netherlands
| | - Otto T H M Lelieveld
- Center of Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Wineke Armbrust
- Department of Children's Rheumatology and Immunology, Beatrix Children's Hospital, Groningen, RB, The Netherlands
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Ververs FA, Eikendal ALM, Kofink D, Nuboer R, Westenberg JJM, Hovenkamp GT, Kemps JJ, Coenen ICJ, Daems JJN, Claus LR, Ju Y, Wulffraat NM, van der Ent CK, Monaco C, Boes M, Leiner T, Grotenhuis HB, Schipper HS. Preclinical Aortic Atherosclerosis in Adolescents With Chronic Disease. J Am Heart Assoc 2022; 11:e024675. [PMID: 35861840 PMCID: PMC9707823 DOI: 10.1161/jaha.122.024675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Adolescents with chronic disease are often exposed to inflammatory, metabolic, and hemodynamic risk factors for early atherosclerosis. Since postmortem studies have shown that atherogenesis starts in the aorta, the CDACD (Cardiovascular Disease in Adolescents with Chronic Disease) study investigated preclinical aortic atherosclerosis in these adolescents.
Methods and Results
The cross‐sectional CDACD study enrolled 114 adolescents 12 to 18 years old with chronic disorders including juvenile idiopathic arthritis, cystic fibrosis, obesity, corrected coarctation of the aorta, and healthy controls with a corrected atrial septal defect. Cardiovascular magnetic resonance was used to assess aortic pulse wave velocity and aortic wall thickness, as established aortic measures of preclinical atherosclerosis. Cardiovascular magnetic resonance showed a higher aortic pulse wave velocity, which reflects aortic stiffness, and higher aortic wall thickness in all adolescent chronic disease groups, compared with controls (
P
<0.05). Age (β=0.253), heart rate (β=0.236), systolic blood pressure (β=−0.264), and diastolic blood pressure (β=0.365) were identified as significant predictors for aortic pulse wave velocity, using multivariable linear regression analysis. Aortic wall thickness was predicted by body mass index (β=0.248) and fasting glucose (β=0.242), next to aortic lumen area (β=0.340). Carotid intima‐media thickness was assessed using ultrasonography, and was only higher in adolescents with coarctation of the aorta, compared with controls (
P
<0.001).
Conclusions
Adolescents with chronic disease showed enhanced aortic stiffness and wall thickness compared with controls. The enhanced aortic pulse wave velocity and aortic wall thickness in adolescents with chronic disease could indicate accelerated atherogenesis. Our findings underscore the importance of the aorta for assessment of early atherosclerosis, and the need for tailored cardiovascular follow‐up of children with chronic disease.
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Affiliation(s)
- Francesca A. Ververs
- Center for Translational Immunology University Medical Center Utrecht Utrecht the Netherlands
| | - Anouk L. M. Eikendal
- Department of Radiology University Medical Center Utrecht Utrecht the Netherlands
| | - Daniel Kofink
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands
| | - Roos Nuboer
- Department of Pediatrics Meander Medical Center Amersfoort Amersfoort the Netherlands
| | | | - Gijs T. Hovenkamp
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Jitske J.A. Kemps
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Iris C. J. Coenen
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Joëlle J. N. Daems
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Laura R. Claus
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Yillie Ju
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Nico M. Wulffraat
- Department of Pediatric Immunology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
- Rare Immunodeficiency, Autoinflammatory and Autoimmune European Reference Network Utrecht the Netherlands
| | - Cornelis K. van der Ent
- Department of Pediatric Pulmonology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Claudia Monaco
- Kennedy Institute of RheumatologyUniversity of Oxford Oxford UK
| | - Marianne Boes
- Center for Translational Immunology University Medical Center Utrecht Utrecht the Netherlands
- Department of Pediatric Immunology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Tim Leiner
- Department of Radiology University Medical Center Utrecht Utrecht the Netherlands
- Department of Radiology Mayo Clinic Rochester MN
| | - Heynric B. Grotenhuis
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Henk S. Schipper
- Center for Translational Immunology University Medical Center Utrecht Utrecht the Netherlands
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
- Kennedy Institute of RheumatologyUniversity of Oxford Oxford UK
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Mondal S, Barman P, Vignesh P. Cardiovascular Abnormalities in Juvenile Dermatomyositis: A Scoping Review for the Clinical Rheumatologists. Front Med (Lausanne) 2022; 9:827539. [PMID: 35814777 PMCID: PMC9263083 DOI: 10.3389/fmed.2022.827539] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
Juvenile dermatomyositis (JDM) is a common form of inflammatory myositis in children. Vasculopathy and endothelial dysfunction play significant roles in the pathogenesis of JDM. Cardiac involvement in JDM is often underestimated, and it may be a potential indicator of poor prognosis. Cardiac dysfunction in JDM can occur both in the acute and chronic stages of the disease. Amongst the acute complications, acute congestive heart failure (CHF), myocarditis, arrhythmia, and complete heart block are common. However, these remain unrecognized due to a lack of overt clinical manifestations. Increased rates of cardiovascular abnormalities have been noted with anti-SRP and anti-Jo 1 auto-antibody positivity. Long-term follow-up studies in JDM have shown an increased prevalence of hypertension, atherosclerosis, coronary artery disease, and metabolic syndrome in adolescence and adulthood. Monitoring of body-mass index, blood pressure, and laboratory evaluation of fasting glucose and lipid profile may help in identifying metabolic syndrome in children with JDM. Steroid-sparing agents, daily exercise, and a healthy diet may reduce such long-term cardiac morbidities. Current use of multimodality imaging such as stress-echocardiography, contrast-enhanced echocardiography, cardiac magnetic resonance imaging, and positron emission tomography has increased the diagnostic yield of subclinical heart disease during acute and chronic stages of JDM. This review elaborates on different aspects of cardiac dysfunction in JDM. It also emphasizes the importance of cardiac screening in long-term follow-up of children with JDM.
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11
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Ciurtin C, Pineda-Torra I, Jury EC, Robinson GA. CD8+ T-Cells in Juvenile-Onset SLE: From Pathogenesis to Comorbidities. Front Med (Lausanne) 2022; 9:904435. [PMID: 35801216 PMCID: PMC9254716 DOI: 10.3389/fmed.2022.904435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/26/2022] [Indexed: 11/25/2022] Open
Abstract
Diagnosis of systemic lupus erythematosus (SLE) in childhood [juvenile-onset (J) SLE], results in a more severe disease phenotype including major organ involvement, increased organ damage, cardiovascular disease risk and mortality compared to adult-onset SLE. Investigating early disease course in these younger JSLE patients could allow for timely intervention to improve long-term prognosis. However, precise mechanisms of pathogenesis are yet to be elucidated. Recently, CD8+ T-cells have emerged as a key pathogenic immune subset in JSLE, which are increased in patients compared to healthy individuals and associated with more active disease and organ involvement over time. CD8+ T-cell subsets have also been used to predict disease prognosis in adult-onset SLE, supporting the importance of studying this cell population in SLE across age. Recently, single-cell approaches have allowed for more detailed analysis of immune subsets in JSLE, where type-I IFN-signatures have been identified in CD8+ T-cells expressing high levels of granzyme K. In addition, JSLE patients with an increased cardiometabolic risk have increased CD8+ T-cells with elevated type-I IFN-signaling, activation and apoptotic pathways associated with atherosclerosis. Here we review the current evidence surrounding CD8+ T-cell dysregulation in JSLE and therapeutic strategies that could be used to reduce CD8+ T-cell inflammation to improve disease prognosis.
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Affiliation(s)
- Coziana Ciurtin
- Centre for Rheumatology Research, Division of Medicine, University College London, London, United Kingdom
- Centre for Adolescent Rheumatology Versus Arthritis, Division of Medicine, University College London, London, United Kingdom
| | - Ines Pineda-Torra
- Centre for Cardiometabolic and Vascular Science, Division of Medicine, University College London, London, United Kingdom
| | - Elizabeth C. Jury
- Centre for Rheumatology Research, Division of Medicine, University College London, London, United Kingdom
| | - George A. Robinson
- Centre for Rheumatology Research, Division of Medicine, University College London, London, United Kingdom
- Centre for Adolescent Rheumatology Versus Arthritis, Division of Medicine, University College London, London, United Kingdom
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Robinson GA, Pineda-Torra I, Ciurtin C, Jury EC. Sex Differences in Lipid Metabolism: Implications for Systemic Lupus Erythematosus and Cardiovascular Disease Risk. Front Med (Lausanne) 2022; 9:914016. [PMID: 35712086 PMCID: PMC9197418 DOI: 10.3389/fmed.2022.914016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
It is known that healthy women during childbearing years have a lower risk of cardiovascular disease (CVD) and coronary heart disease compared to age matched men. Various traditional risk factors have been shown to confer differential CVD susceptibilities by sex. Atherosclerosis is a major cause of CVD and mortality and sex differences in CVD risk could be due to reduced atherogenic low and very low-density lipoproteins (LDL and VLDL) and increased atheroprotective high density lipoproteins (HDLs) in women. In contrast, patients with systemic lupus erythematosus (SLE), a chronic inflammatory disease that predominately affects women, have an increased atherosclerotic and CVD risk. This increased CVD risk is largely associated with dyslipidaemia, the imbalance of atherogenic and atheroprotective lipoproteins, a conventional CVD risk factor. In many women with SLE, dyslipidaemia is characterised by elevated LDL and reduced HDL, eradicating the sex-specific CVD protection observed in healthy women compared to men. This review will explore this paradox, reporting what is known regarding sex differences in lipid metabolism and CVD risk in the healthy population and transgender individuals undergoing cross-sex hormone therapy, and provide evidence for how these differences may be compromised in an autoimmune inflammatory disease setting. This could lead to better understanding of mechanistic changes in lipid metabolism driving the increased CVD risk by sex and in autoimmunity and highlight potential therapeutic targets to help reduce this risk.
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Affiliation(s)
- George A. Robinson
- Division of Medicine, Centre for Rheumatology Research, University College London, London, United Kingdom
- Division of Medicine, Centre for Adolescent Rheumatology Versus Arthritis, University College London, London, United Kingdom
| | - Ines Pineda-Torra
- Division of Medicine, Centre for Cardiometabolic and Vascular Science, University College London, London, United Kingdom
| | - Coziana Ciurtin
- Division of Medicine, Centre for Rheumatology Research, University College London, London, United Kingdom
- Division of Medicine, Centre for Adolescent Rheumatology Versus Arthritis, University College London, London, United Kingdom
| | - Elizabeth C. Jury
- Division of Medicine, Centre for Rheumatology Research, University College London, London, United Kingdom
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13
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Metabolomics Defines Complex Patterns of Dyslipidaemia in Juvenile-SLE Patients Associated with Inflammation and Potential Cardiovascular Disease Risk. Metabolites 2021; 12:metabo12010003. [PMID: 35050125 PMCID: PMC8779263 DOI: 10.3390/metabo12010003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 01/21/2023] Open
Abstract
Cardiovascular disease (CVD) is a leading cause of mortality in patients with juvenile-onset systemic lupus erythematosus (JSLE) associated with atherosclerosis. The interplay between dyslipidaemia and inflammation—mechanisms that drive atherosclerosis—were investigated retrospectively in adolescent JSLE patients using lipoprotein-based serum metabolomics in patients with active and inactive disease, compared to healthy controls (HCs). Data was analysed using machine learning, logistic regression, and linear regression. Dyslipidaemia in JSLE patients was characterised by lower levels of small atheroprotective high-density lipoprotein subsets compared to HCs. These changes were exacerbated by active disease and additionally associated with significantly higher atherogenic very-low-density lipoproteins (VLDL) compared to patients with low disease activity. Atherogenic lipoprotein subset expression correlated positively with clinical and serological markers of JSLE disease activity/inflammation and was associated with disturbed liver function, and elevated expression of T-cell and B-cell lipid rafts (cell signalling platforms mediating immune cell activation). Finally, exposing VLDL/LDL from patients with active disease to HC lymphocytes induced a significant increase in lymphocyte lipid raft activation compared to VLDL/LDL from inactive patients. Thus, metabolomic analysis identified complex patterns of atherogenic dyslipidaemia in JSLE patients associated with inflammation. This could inform lipid-targeted therapies in JSLE to improve cardiovascular outcomes.
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14
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Robinson GA, Peng J, Peckham H, Radziszewska A, Butler G, Pineda-Torra I, Jury EC, Ciurtin C. Sex hormones drive changes in lipoprotein metabolism. iScience 2021; 24:103257. [PMID: 34761181 PMCID: PMC8567005 DOI: 10.1016/j.isci.2021.103257] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/08/2021] [Accepted: 10/07/2021] [Indexed: 02/06/2023] Open
Abstract
Women have a reduced cardiovascular disease (CVD) risk compared with men, which could be partially driven by sex hormones influencing lipid levels post puberty. The interrelationship between sex hormones and lipids was explored in pre-pubertal children, young post-pubertal cis-men/women, and transgender individuals on cross-sex-hormone treatment (trans-men/women) using serum metabolomics assessing 149 lipids. High-density lipoproteins (HDL, typically atheroprotective) were significantly increased and very-low- and low-density lipoproteins (typically atherogenic) were significantly decreased in post-pubertal cis-women compared with cis-men. These differences were not observed pre-puberty and were induced appropriately by cross-sex-hormone treatment in transgender individuals, supporting that sex hormones regulate lipid metabolism in vivo. Only atheroprotective apolipoprotein (Apo)A1 expressing lipoproteins (HDL) were differentially expressed between all hormonally unique comparisons. Thus, estradiol drives a typically atheroprotective lipid profile through upregulation of HDL/ApoA1, which could contribute to the sexual dimorphism observed in CVD risk post puberty. Together, this could inform sex-specific therapeutic strategies for CVD management.
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Affiliation(s)
- George A. Robinson
- Centre for Rheumatology Research, Division of Medicine, University College London, Rayne Building, London WC1E 6JF, UK
- Centre for Adolescent Rheumatology Research, Division of Medicine, University College London, Rayne Building, London WC1E 6JF, UK
| | - Junjie Peng
- Centre for Adolescent Rheumatology Research, Division of Medicine, University College London, Rayne Building, London WC1E 6JF, UK
| | - Hannah Peckham
- Centre for Adolescent Rheumatology Research, Division of Medicine, University College London, Rayne Building, London WC1E 6JF, UK
| | - Anna Radziszewska
- Centre for Adolescent Rheumatology Research, Division of Medicine, University College London, Rayne Building, London WC1E 6JF, UK
| | - Gary Butler
- Department of Paediatric and Adolescent Endocrinology, UCLH and Great Ormond Street Institute of Child Health, University College London, London, UK
- Gender Identity Development Service (GIDS), Tavistock and Portman NHS Foundation Trust, London, UK
| | - Ines Pineda-Torra
- Centre for Cardiometabolic and Vascular Science, Department of Medicine, University College London, London WC1E 6JF, UK
| | - Elizabeth C. Jury
- Centre for Rheumatology Research, Division of Medicine, University College London, Rayne Building, London WC1E 6JF, UK
| | - Coziana Ciurtin
- Centre for Rheumatology Research, Division of Medicine, University College London, Rayne Building, London WC1E 6JF, UK
- Centre for Adolescent Rheumatology Research, Division of Medicine, University College London, Rayne Building, London WC1E 6JF, UK
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15
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Tsabedze N, Seboka M, Mpanya D, Solomon A. Extensive triple vessel coronary artery disease in a young male with juvenile idiopathic arthritis. Oxf Med Case Reports 2021; 2021:omab119. [PMID: 34987849 PMCID: PMC8713581 DOI: 10.1093/omcr/omab119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/30/2021] [Accepted: 07/18/2021] [Indexed: 12/04/2022] Open
Abstract
The risk of cardiovascular disease in patients with chronic inflammatory joint conditions is substantially increased compared to the general population. We present a case of a 27-year-old male with a chronic history of juvenile idiopathic arthritis (JIA) who presented with denovo acutely decompensated chronic heart failure. He had no traditional risk factors for atherosclerotic cardiovascular disease (ASCVD). However, during his workup for dilated cardiomyopathy, he was found to have extensive triple vessel disease on coronary artery angiography, and this was subsequently thought to be the most likely aetiology for the dilated cardiomyopathy despite being of young age. The chronic JIA was identified as the principal risk factor for the ischaemic cardiomyopathy. Clinicians treating patients with rheumatological conditions should routinely screen for ASCVD, despite the absence of traditional cardiovascular risk factors.
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Affiliation(s)
- Nqoba Tsabedze
- Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mpoti Seboka
- Division of Rheumatology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dineo Mpanya
- Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ahmed Solomon
- Division of Rheumatology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Greenan-Barrett J, Doolan G, Shah D, Virdee S, Robinson GA, Choida V, Gak N, de Gruijter N, Rosser E, Al-Obaidi M, Leandro M, Zandi MS, Pepper RJ, Salama A, Jury EC, Ciurtin C. Biomarkers Associated with Organ-Specific Involvement in Juvenile Systemic Lupus Erythematosus. Int J Mol Sci 2021; 22:7619. [PMID: 34299237 PMCID: PMC8306911 DOI: 10.3390/ijms22147619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 12/16/2022] Open
Abstract
Juvenile systemic lupus erythematosus (JSLE) is characterised by onset before 18 years of age and more severe disease phenotype, increased morbidity and mortality compared to adult-onset SLE. Management strategies in JSLE rely heavily on evidence derived from adult-onset SLE studies; therefore, identifying biomarkers associated with the disease pathogenesis and reflecting particularities of JSLE clinical phenotype holds promise for better patient management and improved outcomes. This narrative review summarises the evidence related to various traditional and novel biomarkers that have shown a promising role in identifying and predicting specific organ involvement in JSLE and appraises the evidence regarding their clinical utility, focusing in particular on renal biomarkers, while also emphasising the research into cardiovascular, haematological, neurological, skin and joint disease-related JSLE biomarkers, as well as genetic biomarkers with potential clinical applications.
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Affiliation(s)
- James Greenan-Barrett
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London WC1E 6DH, UK; (J.G.-B.); (G.D.); (D.S.); (G.A.R.); (V.C.); (N.d.G.); (E.R.)
| | - Georgia Doolan
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London WC1E 6DH, UK; (J.G.-B.); (G.D.); (D.S.); (G.A.R.); (V.C.); (N.d.G.); (E.R.)
| | - Devina Shah
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London WC1E 6DH, UK; (J.G.-B.); (G.D.); (D.S.); (G.A.R.); (V.C.); (N.d.G.); (E.R.)
| | - Simrun Virdee
- Department of Ophthalmology, Royal Free Hospital, London NW3 2QG, UK;
| | - George A. Robinson
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London WC1E 6DH, UK; (J.G.-B.); (G.D.); (D.S.); (G.A.R.); (V.C.); (N.d.G.); (E.R.)
| | - Varvara Choida
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London WC1E 6DH, UK; (J.G.-B.); (G.D.); (D.S.); (G.A.R.); (V.C.); (N.d.G.); (E.R.)
| | - Nataliya Gak
- Department of Rheumatology, University College London Hospital NHS Foundation Trust, London NW1 2BU, UK; (N.G.); (M.L.)
| | - Nina de Gruijter
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London WC1E 6DH, UK; (J.G.-B.); (G.D.); (D.S.); (G.A.R.); (V.C.); (N.d.G.); (E.R.)
| | - Elizabeth Rosser
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London WC1E 6DH, UK; (J.G.-B.); (G.D.); (D.S.); (G.A.R.); (V.C.); (N.d.G.); (E.R.)
| | - Muthana Al-Obaidi
- Department of Paediatric Rheumatology, Great Ormond Street Hospital, London WC1N 3JH, UK;
- NIHR Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Maria Leandro
- Department of Rheumatology, University College London Hospital NHS Foundation Trust, London NW1 2BU, UK; (N.G.); (M.L.)
- Centre for Rheumatology, Division of Medicine, University College London, London WC1E 6DH, UK;
| | - Michael S. Zandi
- Department of Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK;
| | - Ruth J. Pepper
- Department of Renal Medicine, Royal Free Hospital, University College London, London NW3 2QG, UK; (R.J.P.); (A.S.)
| | - Alan Salama
- Department of Renal Medicine, Royal Free Hospital, University College London, London NW3 2QG, UK; (R.J.P.); (A.S.)
| | - Elizabeth C. Jury
- Centre for Rheumatology, Division of Medicine, University College London, London WC1E 6DH, UK;
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London WC1E 6DH, UK; (J.G.-B.); (G.D.); (D.S.); (G.A.R.); (V.C.); (N.d.G.); (E.R.)
- Department of Rheumatology, University College London Hospital NHS Foundation Trust, London NW1 2BU, UK; (N.G.); (M.L.)
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Rodrigues WDR, Sarni ROS, Fonseca FLA, Araújo A, Len CA, Terreri MT. Biomarkers of lipid metabolism in patients with juvenile idiopathic arthritis: relationship with disease subtype and inflammatory activity. Pediatr Rheumatol Online J 2021; 19:66. [PMID: 33941215 PMCID: PMC8091710 DOI: 10.1186/s12969-021-00538-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To describe the biomarkers of lipid metabolism in children and adolescents with polyarticular and systemic JIA and to relate them to diseases subtypes, diseases activity markers, and nutritional status. METHODS A cross-sectional study including 62 JIA patients was performed. The following variables were evaluated: disease activity and medications used, body mass index, height for age (z-score), skin folds (bicipital, tricipital, subscapular and suprailiac), food intake based on three 24-h food recalls, lipid profile (total cholesterol (CT), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG) and non-HDL (N-HDLc), glycemia and insulin, erythrocyte sedimentation rate (ESR), ultrasensitive C-reactive protein (us-CRP) and apolipoproteins A-I and B (Apo A-I and Apo B). RESULTS Dyslipidemia was observed in 83.3% of the patients. Based on classical lipid profile, low HDL-c levels was the most frequently alteration observed. Inadequate levels of LDL-c, Apo B and NHDL-c were significantly more frequent in the systemic JIA subtype when compared to the polyarticular subtype (p = 0.017, 0.001 and 0.042 respectively). Patients on biological therapy had a better adequacy of Apo A-I concentrations. The ESR showed a negative correlation with Apo A-I level (r = - 0.25, p = 0.047). CONCLUSION We concluded that dyslipidemia is common in patients with JIA, especially in systemic subtype. The systemic subtype and an elevated ESR were associated with lower concentrations of Apo A-I, suggesting the participation of the inflammatory process.
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Affiliation(s)
- Wellington Douglas Rocha Rodrigues
- Department of Pediatrics, Universidade Federal de São Paulo, Rua Borges Lagoa, 802 - Vila Clementino, São Paulo, SP, CEP: 04038-001, Brazil
| | - Roseli Oselka Saccardo Sarni
- Department of Pediatrics, Universidade Federal de São Paulo, Rua Borges Lagoa, 802 - Vila Clementino, São Paulo, SP, CEP: 04038-001, Brazil
| | - Fernando Luiz Affonso Fonseca
- Department of Pediatrics, Universidade Federal de São Paulo, Rua Borges Lagoa, 802 - Vila Clementino, São Paulo, SP, CEP: 04038-001, Brazil
| | - Annelyse Araújo
- Department of Pediatrics, Universidade Federal de São Paulo, Rua Borges Lagoa, 802 - Vila Clementino, São Paulo, SP, CEP: 04038-001, Brazil
| | - Claudio Arnaldo Len
- Department of Pediatrics, Universidade Federal de São Paulo, Rua Borges Lagoa, 802 - Vila Clementino, São Paulo, SP, CEP: 04038-001, Brazil
| | - Maria Teresa Terreri
- Department of Pediatrics, Universidade Federal de São Paulo, Rua Borges Lagoa, 802 - Vila Clementino, São Paulo, SP, CEP: 04038-001, Brazil.
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18
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Robinson GA, Waddington KE, Coelewij L, Peng J, Naja M, Wincup C, Radziszewska A, Peckham H, Isenberg DA, Ioannou Y, Ciurtin C, Pineda-Torra I, Jury EC. Increased apolipoprotein-B:A1 ratio predicts cardiometabolic risk in patients with juvenile onset SLE. EBioMedicine 2021; 65:103243. [PMID: 33640328 PMCID: PMC7992074 DOI: 10.1016/j.ebiom.2021.103243] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cardiovascular disease is a leading cause of mortality in patients with juvenile-onset systemic lupus erythematosus (JSLE). Traditional factors for cardiovascular risk (CVR) prediction are less robust in younger patients. More reliable CVR biomarkers are needed for JSLE patient stratification and to identify therapeutic approaches to reduce cardiovascular morbidity and mortality in JSLE. METHODS Serum metabolomic analysis (including >200 lipoprotein measures) was performed on a discovery (n=31, median age 19) and validation (n=31, median age 19) cohort of JSLE patients. Data was analysed using cluster, receiver operating characteristic analysis and logistic regression. RNA-sequencing assessed gene expression in matched patient samples. FINDINGS Hierarchical clustering of lipoprotein measures identified and validated two unique JSLE groups. Group-1 had an atherogenic and Group-2 had an atheroprotective lipoprotien profile. Apolipoprotein(Apo)B:ApoA1 distinguished the two groups with high specificity (96.2%) and sensitivity (96.7%). JSLE patients with high ApoB:ApoA1 ratio had increased CD8+ T-cell frequencies and a CD8+ T-cell transcriptomic profile enriched in genes associated with atherogenic processes including interferon signaling. These metabolic and immune signatures overlapped statistically significantly with lipid biomarkers associated with sub-clinical atherosclerosis in adult SLE patients and with genes overexpressed in T-cells from human atherosclerotic plaque respectively. Finally, baseline ApoB:ApoA1 ratio correlated positively with SLE disease activity index (r=0.43, p=0.0009) and negatively with Lupus Low Disease Activity State (r=-0.43, p=0.0009) over 5-year follow-up. INTERPRETATION Multi-omic analysis identified high ApoB:ApoA1 as a potential biomarker of increased cardiometabolic risk and worse clinical outcomes in JSLE. ApoB:ApoA1 could help identify patients that require increased disease monitoring, lipid modification or lifestyle changes. FUNDING Lupus UK, The Rosetrees Trust, British Heart Foundation, UCL & Birkbeck MRC Doctoral Training Programme and Versus Arthritis.
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Affiliation(s)
- George A Robinson
- Centre for Rheumatology Research, Department of Medicine, University College London, Rayne Building, London W1CE 6JF, UK; Centre for Adolescent Rheumatology Versus Arthritis, Department of Medicine, University College London, Rayne Building, London W1CE 6JF, UK.
| | - Kirsty E Waddington
- Centre for Rheumatology Research, Department of Medicine, University College London, Rayne Building, London W1CE 6JF, UK; Centre for Cardiometabolic and Vascular Science, Department of Medicine, University College London, London W1CE 6JF, UK
| | - Leda Coelewij
- Centre for Rheumatology Research, Department of Medicine, University College London, Rayne Building, London W1CE 6JF, UK; Centre for Cardiometabolic and Vascular Science, Department of Medicine, University College London, London W1CE 6JF, UK
| | - Junjie Peng
- Centre for Rheumatology Research, Department of Medicine, University College London, Rayne Building, London W1CE 6JF, UK; Centre for Adolescent Rheumatology Versus Arthritis, Department of Medicine, University College London, Rayne Building, London W1CE 6JF, UK
| | - Meena Naja
- Centre for Adolescent Rheumatology Versus Arthritis, Department of Medicine, University College London, Rayne Building, London W1CE 6JF, UK
| | - Chris Wincup
- Centre for Rheumatology Research, Department of Medicine, University College London, Rayne Building, London W1CE 6JF, UK
| | - Anna Radziszewska
- Centre for Adolescent Rheumatology Versus Arthritis, Department of Medicine, University College London, Rayne Building, London W1CE 6JF, UK
| | - Hannah Peckham
- Centre for Adolescent Rheumatology Versus Arthritis, Department of Medicine, University College London, Rayne Building, London W1CE 6JF, UK
| | - David A Isenberg
- Centre for Rheumatology Research, Department of Medicine, University College London, Rayne Building, London W1CE 6JF, UK; Centre for Adolescent Rheumatology Versus Arthritis, Department of Medicine, University College London, Rayne Building, London W1CE 6JF, UK
| | - Yiannis Ioannou
- Centre for Adolescent Rheumatology Versus Arthritis, Department of Medicine, University College London, Rayne Building, London W1CE 6JF, UK
| | - Coziana Ciurtin
- Centre for Rheumatology Research, Department of Medicine, University College London, Rayne Building, London W1CE 6JF, UK; Centre for Adolescent Rheumatology Versus Arthritis, Department of Medicine, University College London, Rayne Building, London W1CE 6JF, UK.
| | - Ines Pineda-Torra
- Centre for Cardiometabolic and Vascular Science, Department of Medicine, University College London, London W1CE 6JF, UK.
| | - Elizabeth C Jury
- Centre for Rheumatology Research, Department of Medicine, University College London, Rayne Building, London W1CE 6JF, UK.
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Chen Y, Ye P, Liu X, Gong C, Li C, Yuan Y, Zheng H, Xu X, Dong H, Kong Q, Yan Y, Mi J. Characteristics of pediatric inpatients with primary and secondary hypertension. Pediatr Investig 2021; 5:28-32. [PMID: 33778424 PMCID: PMC7983996 DOI: 10.1002/ped4.12249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/14/2021] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Extensive population-based studies have explored the prevalence of primary hypertension (HTN) in children and adolescents. However, there is little published data on the characteristics of different types of pediatric HTN and the causes of secondary HTN. OBJECTIVE To investigate the characteristics of different types of pediatric HTN and the causes of secondary HTN in a hospital setting. METHODS The study cohort comprised pediatric inpatients (<18 years of age) discharged with a diagnosis of HTN from Beijing Children's Hospital during 2015-2020. Pediatric patients with HTN were allocated to secondary and primary HTN groups on the basis of comprehensive analyses of their diagnoses, family history of HTN, and findings on physical examination, as documented in their medical records. The Mann-Whitney U test, χ 2 and Fisher's exact test were used to assess differences in characteristics of patients with different HTN types and causes of secondary HTN. RESULTS Data of 1470 inpatients with HTN from 18 clinical departments were included in the analysis. Among them, 458 (31.2%) had primary HTN, and 1012 (68.8%) had secondary HTN. Compared with patients had primary HTN, children with secondary HTN were younger and had lower body mass indexes and longer lengths of stay. Moreover, children with primary HTN had mostly been managed by the Endocrinology and Cardiology Departments, 75.8% of them having obesity-related comorbidities. In contrast, most patients with secondary HTN had been managed by the Nephrology Department, renal diseases being the leading cause of their HTN (46.3%). INTERPRETATION Secondary HTN is more common than primary HTN in pediatric clinical settings, renal diseases being the leading cause of secondary HTN.
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Affiliation(s)
- Yijun Chen
- Department of Non‐communicable Disease ManagementBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Peiyu Ye
- Department of Non‐communicable Disease ManagementBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Xiaorong Liu
- Department of NephrologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Chunxiu Gong
- Department of Endocrinology, Genetics and MetabolismBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Caifeng Li
- Department of RheumatologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Yue Yuan
- Department of CardiologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Huyong Zheng
- Hematology Oncology CenterBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Xin Xu
- Information CenterBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Hongbo Dong
- Department of Non‐communicable Disease ManagementBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Qin Kong
- Information CenterBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Yinkun Yan
- Department of Non‐communicable Disease ManagementBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Jie Mi
- Department of Non‐communicable Disease ManagementBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
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20
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Pereira L, Previdelli ÁN, Rossi RGDT, Rodrigues WD, Fonseca FLA, Len CA, Terreri MT, Saccardo Sarni RO. Anthropometric Evaluation and Assessment of Food Intake of Parents of Pediatric Patients with Chronic Rheumatic Diseases. ANNALS OF NUTRITION AND METABOLISM 2021; 76:387-395. [PMID: 33540406 DOI: 10.1159/000512243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/29/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Parents' eating behavior, lifestyle, and food choices can interfere with their children's eating habits, bringing new perspectives for the development of beneficial interventions in the context of chronic rheumatic diseases. OBJECTIVES The objective is to evaluate BMI, dietary intake, physical activity, and biomarkers of lipid metabolism in parents of children and adolescents with chronic rheumatic diseases and to verify the association with those of their children. METHODS This is a cross-sectional study with 91 parents, and their respective children diagnosed with juvenile idiopathic arthritis (n = 30, 33.0%), juvenile systemic lupus erythematosus (n = 41, 45.0%), and juvenile dermatomyositis (n = 20, 22.0%). Anthropometric and dietary data, physical activity, lipid profile, and apolipoproteins A-I and B were evaluated. RESULTS In total, 67% of parents and 27.5% of children were overweight; 80% of overweight children/adolescents also had parents with the same nutritional diagnosis. We found a moderate association of total fat intake (Cramer's V test = 0.254; p = 0.037), and a weak association of saturated fat intake (Cramer's V test = 0.219; p = 0.050) and cholesterol intake (Cramer's V test = 0.234; p = 0.025) between parents and their children. A high prevalence of dyslipidemia was observed for parents (82.4%) and children (83.5%), however, with no association between both. A weak association was found between parents and children (Cramer's V test = 0.238; p = 0.024) for triglycerides, and no association was found between parents and children concerning physical activity. CONCLUSION The high frequency of overweight and dyslipidemia observed in parents, combined with the association between the fat intake by parents and their children with chronic rheumatic diseases, points to the importance of intervention strategies with the engagement and participation of families.
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Affiliation(s)
- Lucila Pereira
- Department of Pediatrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Ágatha Nogueira Previdelli
- Health Sciences, USP School of Public Health, São Paulo, Brazil.,Aging Sciences, São Judas University, São Paulo, Brazil
| | - Rosana Gomes de Torres Rossi
- Nutrition and Metabolism, ABC Foundation School of Medicine, São Paulo, Brazil.,São Judas University, São Paulo, Brazil
| | - Wellington Douglas Rodrigues
- Pediatrics Nutrition and Pediatrics Applied Sciences, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,University of the United Metropolitan Faculties, São Paulo, Brazil
| | | | - Claudio Arnaldo Len
- Department of Pediatrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Maria Teresa Terreri
- Department of Pediatrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Alian SM, Esmail HA, Gabr MM, Elewa EA. Predictors of subclinical cardiovascular affection in Egyptian patients with juvenile idiopathic arthritis subtypes. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2020. [DOI: 10.1186/s43166-020-00002-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To assess the subclinical cardiovascular affection in juvenile idiopathic arthritis (JIA) Egyptian patient subtypes using Doppler ultrasonography (US) for carotid and femoral arteries and detecting their predictors
Results
Forty percent of the patients were polyarticular type, while 40% were systemic onset and 20% were oligoarticular. There was a statistically significant difference between JIA and controls in all parameters of subclinical atherosclerosis by ultrasonography except right external carotid velocity and (right and left) femoral velocity. There was also a highly significant increase in intima-media thickness (IMT) in systemic onset type of JIA. There was a statistically positive correlation between increased internal carotid velocity (right and left) and high erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hs-CRP), lipid profile, and disease activity. High disease activity and lipid profile were valid predictors of subclinical atherosclerotic cardiovascular affection in JIA.
Conclusion
Increased cardiovascular risks and subclinical atherosclerosis in patients with JIA especially systemic onset type may be due to higher prevalence of multiple risk factors in these patients. Doppler ultrasonography is a simple, non-invasive technique which can be used to detect subclinical atherosclerosis in JIA. Control of disease activity by treat to target strategy and proper diet control should be applied for every patient with JIA especially those with systemic onset type for future prevention of cardiovascular disease.
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Assessment of traditional and non-traditional risk factors for premature atherosclerosis in children with juvenile dermatomyositis and pediatric controls. Pediatr Rheumatol Online J 2020; 18:25. [PMID: 32183829 PMCID: PMC7079406 DOI: 10.1186/s12969-020-0415-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/02/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Children with juvenile dermatomyositis (JDM), the most common inflammatory myopathy of childhood, may be at increased risk of premature atherosclerosis given a host of traditional and non-traditional risk factors. The primary aim of this study was to determine the underlying frequency of premature atherosclerosis in children with JDM compared to pediatric controls using flow-mediated dilation as a measure of endothelial function. METHODS Children and adolescents with and without JDM were evaluated for traditional atherosclerotic risk factors and assessment of endothelial function, using Endothelial Pulse Amplitude Testing (Endo-PAT). RESULTS In this study, 75% of pediatric controls were of Black or Hispanic descent (compared to 55% in the JDM group) and 70% were found to live in a household with a medium income less than $50,000/year (compared to 45% in the JDM group). Among traditional atherogenic risk factors, lipoprotein A appeared to be different between controls and JDM patients (66 nmol/L and 16.5 nmol/L, respectively). Using a reactive hyperemia index (RHI) < 1.67 as evidence of endothelial dysfunction, 75% of controls were defined as having endothelial dysfunction compared to 50% in JDM group. When controlled for lipoprotein A as an atherogenic confounder, JDM patients were found to have a 41% increase in RHI, thus indicating less endothelial dysfunction compared to controls. CONCLUSIONS In this study, we have shown that atherogenic risk factors are present in the pediatric population and may be associated with endothelial dysfunction, even at very young ages. Despite increasing concerns that children with rheumatologic disorders may be at increased risk of developing premature atherosclerosis, traditional and sociodemographic features may play a greater role in the ultimate development of cardiovascular disease.
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Harrison MJ, Zühlke LJ, Lewandowski LB, Scott C. Pediatric systemic lupus erythematosus patients in South Africa have high prevalence and severity of cardiac and vascular manifestations. Pediatr Rheumatol Online J 2019; 17:76. [PMID: 31771606 PMCID: PMC6878620 DOI: 10.1186/s12969-019-0382-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/13/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Pediatric onset of systemic lupus erythematosus (SLE) is associated with major organ involvement, and African patients tend to develop more aggressive disease than patients of European descent. Although cardiovascular involvement is common in pediatric SLE, there are few published reports on the subject. This study describes the frequency and characteristics of cardiac and vascular manifestations of pediatric SLE in a multi-ethnic South African cohort. METHODS Demographic, clinical, and echocardiographic data were collected from pediatric SLE patients at two centers in Cape Town, South Africa. At the time of investigation, this cohort consisted of 93 participants diagnosed with SLE according to international classification criteria prior to the age of 19. Individuals with cardiac and/or vascular involvement were identified by retrospective chart review. Cardiac manifestations were defined as presence of pericardial effusion, myocarditis, cardiomyopathy, cardiac failure, Libman-Sacks endocarditis, myocardial infarction, and arrhythmia. Vascular manifestations included deep vein thrombosis, pulmonary embolism, sinus thrombosis, stroke, critical limb ischemia, cerebral vasculitis and systemic vasculitis. Statistical analysis was performed using R (v3.4.1). RESULTS Cardiac and vascular involvement was present in 47% of the cohort. Previous studies have reported prevalence of 5%-50%. Demographic features of those with cardiac/vascular involvement did not differ from the overall cohort. Echocardiographic data were available for 23 participants. The most common cardiac manifestations were pericardial effusion (n = 24) and cardiac failure (n = 8), while the most common vascular manifestations were cerebral vasculitis (n = 9), stroke (n = 7), and pulmonary embolism (n = 7). Cardiovascular manifestations were frequently severe; one third of pericardial effusion cases required intervention, including three cases of cardiac tamponade. Cardiac and vascular involvement conferred an increased risk of mortality (31.1% versus 10.4%). CONCLUSIONS Cardiac and vascular involvement were highly prevalent in this South African cohort. The mortality rate was high, and severe manifestations were frequent. Prospective research is needed to improve knowledge of pediatric SLE in Africa and to improve outcomes for this high-risk population.
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Affiliation(s)
- Michael J. Harrison
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Liesl J. Zühlke
- Division of Pediatric Cardiology, Department of Pediatrics, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Laura B. Lewandowski
- National Institute of Arthritis, Musculoskeletal, and Skin Diseases, NIH, DHHS, 9000 Rockville Pike, Building 10, 12N248 Room 28, Bethesda, MD 20892-1102 USA
| | - Christiaan Scott
- Division of Pediatric Rheumatology, Department of Pediatrics, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
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El-Gamasy MA, Abd Elsalam MM, Abd-El Latif AM, Elsaid HH. Predictive values of dyslipidemia and B-type natriuretic peptide levels in juvenile systemic lupus erythematosus: A two center-experience. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2019; 30:863-872. [PMID: 31464243 DOI: 10.4103/1319-2442.265462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
B-type natriuretic peptide (BNP) is a biomarker that helps in determining the diagnosis and prognosis of heart failure (HF). There is an increased risk for cardiovascular disease (CVD) in systemic lupus erythematosus (SLE) with high disease activity, demonstrated by the higher frequency of dyslipidemia and higher BNP concentrations than in healthy controls. The aim of the work was to evaluate the association between the levels of lipids and BNP in pediatric patients with SLE with HF. We classified our subjects into three groups as follows: Group 1 (active SLE group): included 38 patients who subgrouped into 16 with HF and 22 without HF; Group 2 (inactive SLE group): included 38 patients, and Group 3 (control group): included 38 apparently healthy children. All children were subjected to complete history taking, clinical examination, SLE disease activity index scoring and investigations included complete blood count, erythrocyte sedimentation rate, 24-h urinary protein, anti-double strand deoxy-ribonucleic acid and anti-nuclear antibody, lipid profile, serum albumin, protein, and BNP. There was a significantly elevated lipid level and decreased high-density lipoproteins in lupus patients than in healthy controls. The dyslipidemia was more prevalent in active SLE. There were significantly elevated BNP levels in lupus patients than in healthy controls. In this study, we found that BNP was a biomarker in determining the diagnosis and prognosis of HF. This study revealed that BNP levels were increased in SLE patients without cardiac symptoms as compared to healthy controls; furthermore, the BNP levels were higher in active SLE patients with HF. The data indicated that there is a high risk for CVD in SLE with high disease activity, as demonstrated by the higher frequency of dyslipidemia and higher BNP concentrations than in healthy controls.
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Affiliation(s)
- Mohamed A El-Gamasy
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | | | - Hanaa Hossney Elsaid
- Department of Clinical Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Ebraheem MF, Sallam RAER, Mohsen MA, El-Kady BA, El-Hawary GE, Baiomy AA. Vascular cell adhesion molecule-1 (VCAM-1), flow mediated dilatation (FMD) and carotid intima media thickness (IMT) in children with juvenile idiopathic arthritis: Relation to disease activity, functional status and fatigue. THE EGYPTIAN RHEUMATOLOGIST 2019. [DOI: 10.1016/j.ejr.2018.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Tarvin SE, O'Neil KM. Systemic Lupus Erythematosus, Sjögren Syndrome, and Mixed Connective Tissue Disease in Children and Adolescents. Pediatr Clin North Am 2018; 65:711-737. [PMID: 30031495 DOI: 10.1016/j.pcl.2018.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Juvenile systemic lupus erythematosus (jSLE), mixed connective tissue disease (jMCTD), and Sjögren syndrome (jSS) are systemic autoimmune and inflammatory disorders with distinct patterns of organ involvement. All are characterized by autoantibody formation, with antinuclear (ANA) and anti-double-stranded DNA common in jSLE, ANA with high-titer ribonucleoprotein antibody in jMCTD, and Sjögren syndrome A and Sjögren syndrome B antibodies + ANA in jSS. Recognition, monitoring, and management for primary care providers are discussed, focusing on the role of primary physicians in recognizing and helping maintain optimal health in children with these potentially life-threatening diseases.
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Affiliation(s)
- Stacey E Tarvin
- Division of Rheumatology, Department of Pediatrics, University of Indiana School of Medicine, Riley Hospital for Children at Indiana University Health, 699 Riley Hospital Drive, Riley Research 307, Indianapolis, IN 46202, USA
| | - Kathleen M O'Neil
- Division of Rheumatology, Department of Pediatrics, University of Indiana School of Medicine, Riley Hospital for Children at Indiana University Health, 699 Riley Hospital Drive, Riley Research 307, Indianapolis, IN 46202, USA.
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Salomão RG, de Carvalho LM, Izumi C, Czernisz ÉS, Rosa JC, Antonini SRR, Bueno AC, Almada MORDV, Coelho-Landell CDA, Jordão AA, Ferriani VPL, Monteiro JP. Homocysteine, folate, hs-C-reactive protein, tumor necrosis factor alpha and inflammatory proteins: are these biomarkers related to nutritional status and cardiovascular risk in childhood-onset systemic lupus erythematosus? Pediatr Rheumatol Online J 2018; 16:4. [PMID: 29316941 PMCID: PMC5761099 DOI: 10.1186/s12969-017-0220-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/21/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Childhood-onset systemic lupus erythematosus (c-SLE) is a chronic autoimmune disease which increases cardiovascular risk factors (CRF) such as elevated homocysteine, TNF-α, and hs-C reactive protein. METHODS We evaluated BMI, waist circumference (WC), 24-h recalls, SLEDAI-2 K, SLICC/ACR-DI, serum levels of homocysteine, folate, TNF-α, hs-C reactive protein, lipid profile, proteomic data, and duration of corticosteroid therapy in 19 c-SLE and 38 healthy volunteers. Physiological and anthropometric variables of c-SLE and healthy controls were compared by ANCOVA. k-cluster was used to separate c-SLE into two different groups with the best and the worst metabolic profile according to previous analysis showing some metabolites that were statistically different from controls, such as homocysteine, TNF-α, hs-CRP and folate levels. These two clusters were again compared with the control group regarding nutritional parameters, lipid profile and also proteomic data. RESULTS Individuals with c-SLE presented higher BMI, WC, homocysteine, triglycerides, TNF-α, hs-CRP and lower folate levels when compared to controls. We found 10 proteins whose relative abundances were statistically different between control group and lupus clusters with the best (LCBMP) and the worst metabolic profile (LCWMP). A significant positive correlation was found between TNF-α and triglycerides and between hs-CRP and duration of corticosteroid therapy. CONCLUSION Cardiovascular disease (CVD) risk parameters were worse in c-SLE. A less protective CVD proteomic profile was found in LCWMP.
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Affiliation(s)
- Roberta Garcia Salomão
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, 14049-900, Ribeirão Preto, São Paulo, Brasil.
| | - Luciana Martins de Carvalho
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, 14049-900, Ribeirão Preto, São Paulo, Brasil
| | - Clarice Izumi
- Protein Chemistry Center, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brasil
| | - Érika Silva Czernisz
- Protein Chemistry Center, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brasil
| | - José César Rosa
- Protein Chemistry Center, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brasil
| | - Sonir Roberto Rauber Antonini
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, 14049-900, Ribeirão Preto, São Paulo, Brasil
| | - Ana Carolina Bueno
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, 14049-900, Ribeirão Preto, São Paulo, Brasil
| | - Maria Olímpia Ribeiro do Vale Almada
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, 14049-900, Ribeirão Preto, São Paulo, Brasil
| | - Carolina de Almeida Coelho-Landell
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, 14049-900, Ribeirão Preto, São Paulo, Brasil
| | - Alceu Afonso Jordão
- Department of Medical Clinical, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brasil
| | - Virgínia Paes Leme Ferriani
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, 14049-900, Ribeirão Preto, São Paulo, Brasil
| | - Jacqueline Pontes Monteiro
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, 14049-900, Ribeirão Preto, São Paulo, Brasil
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Armbrust W, Bos GJFJ, Wulffraat NM, van Brussel M, Cappon J, Dijkstra PU, Geertzen JHB, Legger GE, van Rossum MAJ, Sauer PJJ, Lelieveld OTHM. Internet Program for Physical Activity and Exercise Capacity in Children With Juvenile Idiopathic Arthritis: A Multicenter Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2017; 69:1040-1049. [DOI: 10.1002/acr.23100] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 08/10/2016] [Accepted: 09/20/2016] [Indexed: 12/28/2022]
Affiliation(s)
- Wineke Armbrust
- University of Groningen, University Medical Center Groningen, and Beatrix Children's Hospital; Groningen The Netherlands
| | - G. J. F. Joyce Bos
- University of Groningen, University Medical Center Groningen; Groningen The Netherlands
| | - Nico M. Wulffraat
- University Medical Center Utrecht and Wilhelmina Children's Hospital; Utrecht The Netherlands
| | - Marco van Brussel
- University Medical Center Utrecht and Wilhelmina Children's Hospital; Utrecht The Netherlands
| | - Jeannette Cappon
- Reade, Center for Rehabilitation and Rheumatology, Dr. Jan van Breemenstraat; Amsterdam The Netherlands
| | - Pieter U. Dijkstra
- University of Groningen, University Medical Center Groningen; Groningen The Netherlands
| | - Jan H. B. Geertzen
- University of Groningen, University Medical Center Groningen; Groningen The Netherlands
| | - G. Elizabeth Legger
- University of Groningen, University Medical Center Groningen, and Beatrix Children's Hospital; Groningen The Netherlands
| | - Marion A. J. van Rossum
- Reade, Center for Rehabilitation and Rheumatology, Dr. Jan van Breemenstraat; Amsterdam The Netherlands
| | - Pieter J. J. Sauer
- University of Groningen, University Medical Center Groningen, and Beatrix Children's Hospital; Groningen The Netherlands
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Picarelli MM, Danzmann LC, Grun LK, Júnior NTR, Lavandovsky P, Guma FTCR, Stein RT, Barbé-Tuana F, Jones MH. Arterial stiffness by oscillometric device and telomere lenght in juvenile idiopathic artrhitis with no cardiovascular risk factors: a cross-sectional study. Pediatr Rheumatol Online J 2017; 15:34. [PMID: 28472973 PMCID: PMC5418721 DOI: 10.1186/s12969-017-0165-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 04/20/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Advances in juvenile idiopathic arthritis (JIA) treatment is promoting free disease survival. Cardiovascular disease (CVD) may emerge as an important cause of morbidity and mortality. Pulse wave velocity (PWV), a surrogate marker of arterial stiffness, and telomere length (TL) are considered as potential predictors of CVD and its outcomes. The study aim was to assess PWV, TL in a JIA population and to test its correlation. In a cross sectional study, 24 JIA patients, 21 controls for TL and 20 controls for PWV were included. PWV was assessed by an oscillometric device. TL was assessed by qPCR. JIA activity was accessed by JADAS-27. Smoking, diabetes, obesity, renal impairment, hypertension, dyslipidemia and inflammatory diseases were excluded. FINDINGS Between cases and controls for TL, there was significant difference in age. No differences in gender, ethnics and bone mass index between JIA and control groups for PWV and TL. The JADAS-27 median was 8. TL was significantly reduced in JIA (0.85 ± 0.34 vs. 1. 67 ± 1.38, P = 0.025). When age adjusted by ANCOVA, the difference remained significant (P = 0,032). PWV was normal in all patients (5.1 ± 0.20 m/s vs. 4.98 ± 0.06 m/s, P = 0, 66). There was no correlation between TL, PWV or JADAS-27. CONCLUSION Compared to controls, JIA with high disease activity and no CVD risk factors have shorter telomeres and normal PWV. As far as we know, this first time this correlation is being tested in rheumatic disease and in paediatrics.
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Affiliation(s)
- Maria Mercedes Picarelli
- Rheumatology Department, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Ipiranga Avenue, 6690/220, Porto Alegre, 90610 000, Brazil.
| | | | - Lucas Kich Grun
- 0000 0001 2200 7498grid.8532.cUniversidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Patrícia Lavandovsky
- 0000 0001 2200 7498grid.8532.cUniversidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Renato T. Stein
- 0000 0001 2198 7041grid.411379.9Rheumatology Department, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Ipiranga Avenue, 6690/220, Porto Alegre, 90610 000 Brazil
| | - Florência Barbé-Tuana
- 0000 0001 2200 7498grid.8532.cUniversidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcus Herbert Jones
- 0000 0001 2198 7041grid.411379.9Rheumatology Department, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Ipiranga Avenue, 6690/220, Porto Alegre, 90610 000 Brazil
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Cavallo S, Brosseau L, Toupin-April K, Wells GA, Smith CA, Pugh AG, Stinson J, Thomas R, Ahmed S, Duffy CM, Rahman P, Àlvarez-Gallardo IC, Loew L, De Angelis G, Feldman DE, Majnemer A, Gagnon IJ, Maltais D, Mathieu MÈ, Kenny GP, Tupper S, Whitney-Mahoney K, Bigford S. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Structured Physical Activity in the Management of Juvenile Idiopathic Arthritis. Arch Phys Med Rehabil 2017; 98:1018-1041. [DOI: 10.1016/j.apmr.2016.09.135] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 08/15/2016] [Accepted: 09/27/2016] [Indexed: 12/31/2022]
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Ahmed EAS, Ganeb SS, El-shambaky AY, Galal OT, Tohamy MY. Study of early atherosclerosis in juvenile-onset systemic lupus erythematosus patients. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2017. [DOI: 10.4103/1110-161x.200835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Su-Angka N, Khositseth A, Vilaiyuk S, Tangnararatchakit K, Prangwatanagul W. Carotid intima-media thickness and arterial stiffness in pediatric systemic lupus erythematosus. Lupus 2017; 26:989-995. [PMID: 28420050 DOI: 10.1177/0961203317692434] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives The carotid intima-media thickness (CIMT) and carotid arterial stiffness index (CASI) act as the surrogate markers of atherosclerosis. We aim to assess CIMT and CASI in pediatric systemic lupus erythematosus (SLE). Methods Patients ≤ 20 years old fulfilling diagnostic criteria for SLE were enrolled. Patients with active smoking, coronary heart disease, cerebrovascular disease, arterial thrombosis, family history of hypercholesterolemia, chronic liver disease, or other chronic severe diseases were excluded. The patients were categorized into four groups: active SLE, age- and sex-matched control (control A), inactive SLE, and age- and sex-matched control (control I), according to the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). All subjects underwent ultrasound of carotid arteries to evaluate CIMT and CASI. Results One hundred and two SLE patients (26 active and 76 inactive) and one hundred and three healthy controls (26 control A and 77 control I) were enrolled. The median CIMT in all groups were not significantly different (0.43, 0.41-0.44; 0.43, 0.41-0.44; 0.42, 0.41-0.43; and 0.42, 0.41-0.43 mm, respectively).The CASI in active SLE (13.5, 11.4-17.3) was significantly higher than in control A (8.2, 7.2-9.2) ( p < 0.0001), whereas CASI in inactive SLE (12.7, 10.9-15.7) was significantly higher than in control I (8.9, 7.6-9.8). However, the CASI in active and inactive SLE was not significantly different. Conclusions The higher CASI in active and inactive pediatric SLE, implying functional change of carotid arteries, may be early evidence of increased atherosclerosis in pediatric SLE. This functional dysfunction has been found both in inactive and active SLE.
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Affiliation(s)
- N Su-Angka
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
| | - A Khositseth
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
| | - S Vilaiyuk
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
| | - K Tangnararatchakit
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
| | - W Prangwatanagul
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
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Machado D, Sarni ROS, Abad TTO, Silva SGL, Khazaal EJB, Hix S, Correia MSG, Suano-Souza FI, Len CA, Terreri MTRA. Lipid profile among girls with systemic lupus erythematosus. Rheumatol Int 2017; 37:43-48. [PMID: 26573664 DOI: 10.1007/s00296-015-3393-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/03/2015] [Indexed: 12/31/2022]
Abstract
The aim of the study was to describe biomarkers of lipid metabolism associated with increased cardiovascular risk and their correlation with disease variables and markers of inflammation in adolescent females with systemic lupus erythematosus (SLE). This cross-sectional controlled study evaluated 33 adolescent females with juvenile SLE and 33 healthy controls. Anthropometric data, SLE disease activity index (SLEDAI), medications, proteinuria, ultra-sensitive C-reactive protein (us-CRP), lipid profile (total cholesterol, LDL-c, HDL-c and triglycerides), apolipoproteins A and B (Apo A-I and B), paraoxonase, and myeloperoxidase were evaluated. Median age of the patients and the median disease duration were 16.7 years and 54 months, respectively. SLEDAI scores above 4 were observed in 11 (33.3 %) patients. Moreover, 12 (36.4 %) patients were overweight, and 5 (15.2 %) had low height for age ratios. Dyslipidemia was observed in 13 (39.4 %) patients and in 7 (21.2 %) controls with a decrease in HDL-c concentrations in SLE patients even after adjustment for their nutritional status. In the group with SLE, us-CRP concentrations were inversely correlated with LDL-c/ApoB ratio (p = 0.031). After multivariate regression analysis, the SLE group showed lower concentration of Apo A-I and a decreased LDL-c/ApoB ratio. SLE adolescent females with low disease activity, with preserved kidney function and on low dose of corticosteroids, regardless of nutritional status and food intake, have proatherogenic lipid biomarkers, which may contribute to an increased atherosclerotic risk.
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Affiliation(s)
- Daniele Machado
- Federal University of São Paulo (Universidade Federal de São Paulo), ABC, Rua Ipê, 112, apto 111, São Paulo, SP, 04022-005, Brazil
| | - Roseli O S Sarni
- Federal University of São Paulo (Universidade Federal de São Paulo), ABC, Rua Ipê, 112, apto 111, São Paulo, SP, 04022-005, Brazil
- Medical School (Faculdade de Medicina do ABC), Santo André, Brazil
| | - Thaís T O Abad
- Federal University of São Paulo (Universidade Federal de São Paulo), ABC, Rua Ipê, 112, apto 111, São Paulo, SP, 04022-005, Brazil
| | - Simone G L Silva
- Federal University of São Paulo (Universidade Federal de São Paulo), ABC, Rua Ipê, 112, apto 111, São Paulo, SP, 04022-005, Brazil
| | - Eugênia J B Khazaal
- Federal University of São Paulo (Universidade Federal de São Paulo), ABC, Rua Ipê, 112, apto 111, São Paulo, SP, 04022-005, Brazil
| | - Sonia Hix
- Medical School (Faculdade de Medicina do ABC), Santo André, Brazil
| | | | - Fabíola I Suano-Souza
- Federal University of São Paulo (Universidade Federal de São Paulo), ABC, Rua Ipê, 112, apto 111, São Paulo, SP, 04022-005, Brazil
- Medical School (Faculdade de Medicina do ABC), Santo André, Brazil
| | - Claudio A Len
- Federal University of São Paulo (Universidade Federal de São Paulo), ABC, Rua Ipê, 112, apto 111, São Paulo, SP, 04022-005, Brazil
| | - Maria Teresa R A Terreri
- Federal University of São Paulo (Universidade Federal de São Paulo), ABC, Rua Ipê, 112, apto 111, São Paulo, SP, 04022-005, Brazil.
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Barsalou J, Bradley TJ, Tyrrell PN, Slorach C, Ng LWK, Levy DM, Silverman ED. Impact of Disease Duration on Vascular Surrogates of Early Atherosclerosis in Childhood-Onset Systemic Lupus Erythematosus. Arthritis Rheumatol 2016; 68:237-46. [PMID: 26361097 DOI: 10.1002/art.39423] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 09/01/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine whether longer disease duration negatively impacts carotid intima-media thickness (CIMT), flow-mediated dilation (FMD), and pulse wave velocity (PWV) in a cohort of patients with childhood-onset systemic lupus erythematosus (SLE), and to compare CIMT, FMD, and PWV in patients with childhood-onset SLE with those in healthy children and explore determinants of vascular test results in childhood-onset SLE. METHODS Cross-sectional analysis was performed in a prospective longitudinal cohort of patients with childhood-onset SLE at the latest followup visit. Clinical and laboratory data were collected for patients with childhood-onset SLE. CIMT, FMD, and PWV were measured using standardized protocols in patients with childhood-onset SLE and healthy children. Correlations between disease duration and results of the 3 vascular tests were performed. Vascular data in patients with childhood-onset SLE were compared with those in healthy children. Multivariable linear regression was used to identify determinants of CIMT, FMD, and PWV in childhood-onset SLE. RESULTS Patients with childhood-onset SLE (n = 149) and healthy controls (n = 178) were enrolled. The median age of the patients was 17.2 years (interquartile range [IQR] 15.7-17.9 years), and their median disease duration was 3.2 years (IQR 1.8-4.9 years). The median age of the healthy children was 14.7 years (IQR 13.1-15.9 years). Longer disease duration correlated with worse FMD (r = -0.2, P = 0.031) in patients with childhood-onset SLE. Patients with childhood-onset SLE had smaller (better) CIMT, higher (better) FMD, and similar PWV compared with healthy controls. Linear regression analysis explained <24% of the variation in vascular test results in patients with childhood-onset SLE, suggesting that other variables should be explored as important determinants of CIMT, FMD, and PWV. CONCLUSION In this cohort of 149 patients with childhood-onset SLE, patients did not have worse CIMT, FMD, or PWV than did healthy controls. Longer disease duration was associated with worse FMD, suggesting progressive endothelial dysfunction over time.
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Affiliation(s)
- Julie Barsalou
- Centre Hospitalier Universitaire St. Justine, University of Montreal, Montreal, Quebec, Canada), Timothy J. Bradley, MBChB, FRACP, Cameron Slorach, RDCS, Lawrence W. K. Ng, BSc, Deborah M. Levy, MD, MS, FRCPC: The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Timothy J Bradley
- Centre Hospitalier Universitaire St. Justine, University of Montreal, Montreal, Quebec, Canada), Timothy J. Bradley, MBChB, FRACP, Cameron Slorach, RDCS, Lawrence W. K. Ng, BSc, Deborah M. Levy, MD, MS, FRCPC: The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Cameron Slorach
- Centre Hospitalier Universitaire St. Justine, University of Montreal, Montreal, Quebec, Canada), Timothy J. Bradley, MBChB, FRACP, Cameron Slorach, RDCS, Lawrence W. K. Ng, BSc, Deborah M. Levy, MD, MS, FRCPC: The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lawrence W K Ng
- Centre Hospitalier Universitaire St. Justine, University of Montreal, Montreal, Quebec, Canada), Timothy J. Bradley, MBChB, FRACP, Cameron Slorach, RDCS, Lawrence W. K. Ng, BSc, Deborah M. Levy, MD, MS, FRCPC: The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Deborah M Levy
- Centre Hospitalier Universitaire St. Justine, University of Montreal, Montreal, Quebec, Canada), Timothy J. Bradley, MBChB, FRACP, Cameron Slorach, RDCS, Lawrence W. K. Ng, BSc, Deborah M. Levy, MD, MS, FRCPC: The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Earl D Silverman
- The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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Mohan S, Barsalou J, Bradley TJ, Slorach C, Reynolds JA, Hasni S, Thompson B, Ng L, Levy D, Silverman E, Kaplan MJ. Endothelial progenitor cell phenotype and function are impaired in childhood-onset systemic lupus erythematosus. Arthritis Rheumatol 2015; 67:2257-62. [PMID: 25891295 DOI: 10.1002/art.39149] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 04/02/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is characterized by increased cardiovascular risk in adult-onset and childhood-onset SLE. Type I interferons (IFNs) appear to play a prominent role in premature vascular damage in adult-onset SLE, at least in part, by inducing impairments in the phenotype and function of endothelial progenitor cells (EPCs), thereby hampering vascular repair. It is not clear whether EPC dysfunction is present in childhood-onset SLE in association with a type I IFN signature. METHODS The phenotype and numbers of EPCs were quantified in patients with childhood-onset SLE, patients with juvenile idiopathic arthritis (JIA), and matched healthy control subjects. In a separate cohort of patients with childhood-onset SLE, markers of subclinical atherosclerosis and endothelial dysfunction were quantified using standardized protocols and analyzed for associations with serum type I IFN activity. RESULTS EPC numbers and function were significantly decreased in patients with childhood-onset SLE compared with patients with JIA and healthy control subjects. Serum from patients with childhood-onset SLE impaired differentiation of EPCs into mature endothelial cells in healthy controls, and this effect was blocked by inhibition of the type I IFN pathway. Type I IFN activity in serum was not significantly associated with subclinical atherosclerosis and endothelial function in patients with childhood-onset SLE. CONCLUSION As in adult-onset SLE, childhood-onset SLE is characterized by phenotypic and functional EPC abnormalities, which are likely triggered by type I IFNs. Although cross-sectional analysis revealed no global association between type I IFN signatures and vascular measures of subclinical atherosclerosis, longitudinal assessments are needed to evaluate whether progression of vascular damage in patients with childhood-onset SLE is associated with type I IFNs, as observed in patients with adult-onset SLE.
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Affiliation(s)
| | | | | | | | - John A Reynolds
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Sarfaraz Hasni
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | - Lawrence Ng
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Deborah Levy
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Mariana J Kaplan
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
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Armbrust W, Bos JJFJ, Cappon J, van Rossum MAJ, Sauer PJJ, Wulffraat N, van Wijnen VK, Lelieveld OTHM. Design and acceptance of Rheumates@Work, a combined internet-based and in person instruction model, an interactive, educational, and cognitive behavioral program for children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2015; 13:31. [PMID: 26202161 PMCID: PMC4511536 DOI: 10.1186/s12969-015-0029-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is a chronic rheumatic disease. Patients suffer daily discomforts such as pain, fatigue, stiffness, and mood disturbances. Their exercise capacity is decreased to a variable degree and physical activity levels may be impaired. To prevent long-term cardiovascular risks associated with JIA and medication, it is important to encourage physical activity. To achieve this we developed Rheumates@Work (R@W), a combined internet-based and in person instruction model, an interactive, educational, and cognitive behavioral program. The aim of this study is twofold: to describe the theoretical background and design of R@W based on Pender's Health Promotion Model, and to assess its acceptance. METHODS We enrolled 8 to 13-year-old JIA patients, from 3 outpatients clinics in The Netherlands, in R@W. Inclusion criteria were a low disease activity (VAS physician <20 mm), comprehension of the Dutch language and absence of relevant co-morbidity. We assessed acceptance by measuring the participants' commitment to the program, the level of interaction on patient's initiative (f.e. mails send by the patient), technical aspects and satisfaction. Commitment was defined as the percentage of participants that completed the assignments and how much encouragement the participants needed for this. Satisfaction was measured with an anonymous questionnaire concerning f.e. time investment and perceived benefits. Costs were monitored. RESULTS Of the 64 patients we enrolled, 23 boys and 41 girls, 93.8 % completed the program. Participant-initiated interaction was seen in 10.7 %, 24.7 % send a mail because of technical problems. Eighty-two percent of the participants and 99 % of the parents liked the program, and 85 % of the participants indicated that they had learnt something, or quite a lot. Development costs of the program were low. CONCLUSION The HPM is suitable for a behavioral intervention program such as R@W. Acceptance and satisfaction of R@W were high and the costs of the program were low. TRIAL NUMBER ISRCTN92733069.
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Affiliation(s)
- Wineke Armbrust
- Department of Pediatric Rheumatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands.
| | - Joyce J. F. J. Bos
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
| | - Jeannette Cappon
- Amsterdam Center for Rheumatology and immunology Reade, location: Dr. Jan van Breemenstraat, Amsterdam, The Netherlands.
| | - Marion A.J. J. van Rossum
- Amsterdam Center for Rheumatology and immunology Reade, location: Dr. Jan van Breemenstraat, Amsterdam, The Netherlands
| | - Pieter J. J. Sauer
- University of Groningen, University Medical Center Groningen, Beatrix Children’s Hospital, Groningen, The Netherlands
| | - Nico Wulffraat
- Department of Paediatric Immunology, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
| | - Veera K. van Wijnen
- Department of Pediatric Rheumatology, University of Groningen, University Medical Center Groningen, Beatrix Children’s Hospital, Groningen, The Netherlands
| | - Otto T. H. M. Lelieveld
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
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Cardiovascular risk in chronic kidney disease patients: intima-media thickness predicts the incidence and severity of histologically assessed medial calcification in radial arteries. BMC Nephrol 2015; 16:78. [PMID: 26037625 PMCID: PMC4453281 DOI: 10.1186/s12882-015-0067-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 05/20/2015] [Indexed: 11/24/2022] Open
Abstract
Background The objective of the study was to determine the relationship between common carotid artery intima-media thickness (CCA-IMT) and histologically assessed calcification of radial artery in relation to clinical features and laboratory markers of bone and mineral metabolism, inflammation, and oxidative stress in patients with stage 5 chronic kidney disease (CKD). Methods The study comprised 59 patients (36 hemodialyzed, 23 predialysis). CCA-IMT was measured by ultrasonography; the biochemical parameters examined were assessed using routine laboratory methods, ELISA micro-plate immunoassays and spectrophotometry. Fragments of radial artery obtained during creation of hemodialysis access were cryosectioned and stained for calcifications using von Kossa method and alizarin red. Results Glucose, osteoprotegerin, pentraxin 3 and Framingham risk score significantly correlated with CCA-IMT. In multiple regression analysis, OPG positively predicted CCA-IMT. Radial artery calcifications were found in 34 patients who showed higher CCA-IMT (0.98 ± 0.13 vs 0.86 ± 0.14 mm; P = 0.006). Higher CCA-IMT values were also associated with more advanced calcifications. CCA-IMT and the presence of plaques in common carotid artery were positive predictors of radial artery calcifications, independent of dialysis status, Framingham risk score, CRP and Ca x Pi [OR for calcifications 2.19 (1.08-4.45) per 0.1 mm increase in CCA-IMT]. The presence of radial artery calcifications was a significant predictor of mortality, independent of dialysis status and Framingham risk score [HR 3.16 (1.03-9.64)]. Conclusions In CKD patients, CCA-IMT examination can be used as a surrogate measure to assess the incidence and severity of arterial medial calcification which is associated with poor clinical outcome in these patients.
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