Predictors of fibrogenesis in children with JIA: a single-center pilot study

BACKGROUND

Patients with rheumatological diseases are at high risk of developing irreversible fibrotic changes, both articular and extra-articular, as a result of tissue damage caused by the chronic phase of persistent inflammation. Thus, our purpose was to study early markers of fibrosis formation in children with juvenile idiopathic arthritis (JIA).

METHODS

Seventy patients with juvenile idiopathic arthritis, namely, polyarthritis (64.29%) and oligoarthritis (35.71%) variant JIA (mean age 13.3 years, 64.29% girls, 35.71% boys), were included in this 4-year prospective study. Basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) levels were determined by ELISA kits.

RESULTS

We evaluated bFGF (mean: 7478.21 pg/ml; min: 4171.56 pg/ml; max: 18,011.25 pg/ml) and VEGF (mean: 342.47 pg/ml; min: 23.68 pg/ml; max: 2158.91 pg/ml) levels in children with JIA. Children with JIA had a higher VEGF level when JIA onset occurred after 15 years of age and they had a high disease activity; additionally, a higher bFGF level was observed in children older than 14 years and in those with a JIA onset after 15 years of age, the oligoarticular variant, a moderate disease activity and regardless of MTX administration but more often when MTX was administered at a dosage from 10 to 12.5 mg/m2/week.

CONCLUSIONS

Laboratory screening of fibrosis formation predictors could help identify patients who may be at greater risk of adverse outcomes. Children with JIA had higher bFGF and VEGF levels when JIA onset occurred after 15 years of age, depending on disease activity.

[ADAPTIVE CAPABILITIES OF THE CARDIOVASCULAR SYSTEM IN ADOLESCENTS WITH NON-INFLAMMATORY MYOCARDIAL PATHOLOGY, TAKING INTO ACCOUNT MORPHOFUNCTIONAL INDICATORS OF THE HEART]

THE AIM OF THE STUDY

to study the adaptive capabilities of the cardiovascular system in children with non-inflammatory myocardial pathologies, taking into account morphofunctional indicators of the right and left ventricles of the heart.

MATERIALS AND METHODS

62 patients with non-inflammatory myocardial pathology were examined, 30 of them with minor abnormalities of the heart, 32 with various rhythm disturbances. The average age of the subjects was 14.56 ± 0.24 years. The morphofunctional state of the myocardium was assessed by the results of ultrasound Doppler examination of the heart in the "M" and "B" modes. To study the tolerance to minimal physical activity and its effect on the state of the cardiovascular system in children, a six-minute walk test was performed. To assess the functional tension of the cardiovascular system before and after six-minute walk test, the following indices were calculated: Allgauer's index, endurance coefficient by the formula of A. Kwaas, Robinson index, coefficient of blood circulation efficiency. To assess the effect of the autonomic nervous system on the performance of the cardiovascular system, the Kerdo Vegetative Index was determined. At rest, the index of functional changes of the circulatory system, or adaptive potential was also determined. As a result of the study, it was noted that children with non-inflammatory heart diseases showed a decrease in systolic myocardial function of both ventricles. In patients with minor abnormalities of the heart, this is accompanied by the formation of dilatation of the left ventricular cavity and an increase in myocardial mass. As a result of the study, it was noted that in children with non-inflammatory heart diseases, a decrease in systolic myocardial function of both ventricles is noted. In patients with MARS, this is accompanied by myocardial remodeling with dilatation of the left ventricular cavity and an increase in myocardial mass. Subclinical decline in functionality is detected in samples with physical activity (six-minute walk test). At the same time, to assess the functional reserves of the circulatory system and the child's body as a whole, as well as its adaptive capabilities, it is advisable to use the Allgover, Robinson indices, endurance coefficient and efficiency of blood circulation.