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.

AB0155 VASCULAR ENDOTHELIAL GROWTH FACTOR IN JUVENILE IDIOPATHIC ARTHRITIS

Background

Vascular changes are preceding the development of fibrosis in juvenile idiopathic arthritis (JIA). Signs of angiogenesis, the process of new vessel formation, cannot be fully detected, especially in childhood. Vascular endothelial growth factor (VEGF) is considered to play a crucial role for angiogenesis regulation [1,2].

Objectives

To evaluate serum levels of vascular endothelial growth factor in the treatment of juvenile idiopathic arthritis.

Methods

104 consecutive JIA patients aged 10 to 18 years (13.3 ± 0.3) were included in this 4-years prospective study. VEGF levels were determined by VEGF ELISA kits. Serum levels of VEGF were analyzed depending on patients’ gender, age, and age of JIA onset, its variant, duration, activity, and presence of methotrexate (MTX) in treatment and its dose.

Results

We evaluated VEGF level for children with JIA (min: 23.68 pg/ml; Me:244.75 pg/ml; max: 2158.91 pg/ml). VEGF in JIA was related to onset of JIA in patients older than 15 years and high disease activity according JADAS-27 pattern (p˂0.05). Levels of circulating immune complex (CIC) and antistreptolysin-o (ASL-O) was associated with VEGF level. Mostly VEGF was correlated with CIC (among: girls r=0.53, patients with oligoarthritis r=0.55, inactive disease activity according to JADAS-27 r=0.47, dose of МТХ, 10–12,5mg/m2/week r=0.67 p ˂ 0.05) and with ASL-O (among: girls r=0.47, inactive disease activity according to JADAS-27 r=0.51, MTX treatment r= 0.36, dose of МТХ, 10–12,5mg/m2/week r=0.90 p ˂ 0.05).

Conclusion

Children with JIA had a higher VEGF level in patients older than 15 years and high disease activity. Also, CIC and ASL-O showed high impact on VEGF level which is the critical factor of angiogenesis.

References

[1]Wu, C. Y., Yang, H. Y., Huang, J. L., & Lai, J. H. (2021). Signals and Mechanisms Regulating Monocyte and Macrophage Activation in the Pathogenesis of Juvenile Idiopathic Arthritis. International journal of molecular sciences, 22(15), 7960. https://doi.org/10.3390/ijms22157960

[2]Świdrowska-Jaros, J., & Smolewska, E. (2018). A fresh look at angiogenesis in juvenile idiopathic arthritis. Central-European journal of immunology, 43(3), 325–330. https://doi.org/10.5114/ceji.2018.80052

Disclosure of Interests

None declared

AB1266 ANGIOTENSIN-CONVERTING ENZYME LEVEL IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS

Background

One of the most common comorbid conditions accompanying rheumatoid arthritis is atherosclerosis and arterial hypertension. Previous studies have shown a change in the blood lipid spectrum with an increase in the atherogenic index in children with juvenile idiopathic arthritis. The next link in the development of this pathology is a change in the endothelial function of the vessels.

Objectives

To study the level of angiotensin-converting enzyme in children with JIA and establish its interdependence with the blood lipid spectrum of sick children.

Methods

The level of angiotensin-converting enzyme (ACE) was studied in 46 children (28 girls and 18 boys) from 11 to 17 years old by enzyme immunoassay as well as indicators of the lipid spectrum: low density lipoprotein cholesterol (LDL), very low-density lipoprotein cholesterol (VLDL) and atherogenic coefficient. The results obtained were compared with the data of children in the control group, which consisted of 34 people. Data were analyzed depending on patients’ gender, age, and age of JIA onset, its variant, duration, activity, and presence of methotrexate (MTX).

Results

The results of the study are presented in the Table 1.

Table 1.Lipid spectrum indicatorsChildren’s groupsM+mMeMinMaxрLDLJIA, n=462,33±0,092,180,974,310,001Control, n=342,5±0,092,551,394,13VLDLJIA, n=460,36±0,090,350,131,10,001Control, n=340,14±0,010,130,060,27KAJIA, n=462,04±0,091,830,823,50,4Control, n=342,03±0,092,020,833,8ACEJIA, n=4641,23±3,935,5914,4101,20,2Control, n=3440,22±6,3746,7517,9763,78

There were no significant differences in the ACE level in children with JIA in comparison with the control group. Analysis of the data obtained did not reveal significant changes in the obtained ACE parameters depending on the gender and age of patients, JIA activity, and the presence of MTX in complex treatment. At the same time, a direct correlation of ACE values ​​and low-density lipoprotein levels (r=0.5, p<0.05) was obtained, which confirms the relationship between the ACE level and the development of dyslipoproteinemia in children with JIA.

Conclusion

The obtained results illustrate the stages of development of atherogenic changes in children with JIA. Data were obtained that against the background of an increase in the level of VLDL and a decrease in LDL, the level of ACE remains preserved, which reflects the absence of changes in the endothelium. Research into these changes is ongoing.

Disclosure of Interests

None declared

AB0986 NT-PROBNP LEVEL IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

Background:

The defeat of the cardiovascular system is considered a proven comorbid state in rheumatic diseases, including rheumatoid arthritis in adults. One of the markers of the cardiovascular failure formation is BNP, namely, its N-terminal inactive fragment (NT-proBNP76), which accumulates in specific granules of cardiomyocytes. Its diagnostic value increases with the appearance of minimally expressed symptoms. The long-term course of JIA is also characterized by changes in the state of the cardiovascular system, and there may be no visible clinical manifestations. For their diagnosis a 6-minute walk test is widely used, including in children.

Objectives:

To study the content of NT-proBNP in patients with juvenile idiopathic arthritis and compare with the level of exercise tolerance.

Methods:

10 patients with JIA (9 girls, 1 boy), average age 12.78 ± 0.95 years, were examined. All children had a polyarticular RF negative subtype of JIA with a disease duration of more than three years (average disease duration 69.56 ± 17.07 months), received basic methotrexate therapy and did not have dysfunction of the lower extremities joints. The control group included 7 healthy children, comparable by sex, average age 14.25±0.73 years. An ECG, an ultrasound scan of the heart, and a 6-minute walk test (6MTX) were carried out with determining the distance traveled (6MWD) and the increase in heart rate. The level of the N-terminal polypeptide of cerebral natriuretic hormone (B-type) (NT-proBNP) was determined in the morning, after waking up, and studied by competitive immunoassay on an IMMULITE 2000 analyzer (“Siemens”).

Results:

In children with JIA a decrease in myocardial contractility was not detected. Left ventricular ejection fraction (62.17±0.83% (60.02 – 64.02) versus 69.84 ± 0.85% (62.3 – 80.3), p <0.05) in children with JIA were within normal limits, but significantly lower than in the control group. According to the results 6MTX indicator 6MWD in JIA-patients was 490.51 ± 11.40 m and in the control group 516.85 ± 8.84 m (p <0.05) and heart rate growth was 27.75 ± 2.30% versus in the control group (37.38 ± 3.86%), p <0.05. A negative correlation between the increase in heart rate and the duration of the disease was found (r = -0.7, p = 0.05). The level of NT-proBNP in patients with JIA was within physiological values and amounted to 47.5 ± 14.09 pg / ml (20 – 128 pg/ml), but this was higher than in children of the control group (20.29 ± 0.29 pg / ml (20-22 pg/ml), p <0.05). A high correlation was found between 6 MWD and NT-proBNP level (r = 0.8, p <0.03).

Conclusion:

In children with JIA there is a decrease of the exercise tolerance that increases with the duration of JIA on the background of preserved myocardial contractility. This is accompanied by a higher basal NT-proBNP level than in healthy children.

Disclosure of Interests:

None declared

[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.

OPTIMIZATION OF THE RECIPES OF FORCEMEAT PRODUCTS ON THE BASIS OF PROCESSED FRESHWATER MUSSELS

This article is devoted to the optimization of the formulations of mincemeat products (cutlets) based on the semi-finished product from the freshwater mussel of the genus Anodonta. Recipe of this semi-finished product that can be introduced into the composition of different groups of dishes and culinary products has been developed. The article presents the model developed of optimisation of the recipe composition of polycomponent systems according to the optimum daily consumption of protein, fats and carbohydrates, with the classical cutlet technology as an example. In the course of the research, a universal model of an orthogonal central composite design to optimize forcemeat products was developed based on the criterion of a balance of the basic nutrients. The orthogonal central composite design is described in detail with four (n) factors of the optimization of the formulations of forcemeat products, and the homogeneity of the dispersion is confirmed, using Cochran’s C test at the significance level of x (0.05). The significance of the statistical model and the reliability of the regression equation were determined with an F-test. An organoleptic evaluation of the composition of each formulation of forcemeat products on the basis of processed freshwater mussels was made during the experiment by analytical methods – the qualitative method and the developed profile analysis method according to a point scale. The obtained results were presented in the form of a 3D model constructed using the least-squares smoothing method. After the graphic data obtained and the results of the direct measurements had been studied and the regression equation interpreted, we determined that the optimum composition of forcemeat products based on the processed freshwater mussel was the sample having the ratio of proteins, fats, and carbohydrates 1:1.03:4.18, which is the closest to the optimum ratio (1:1:4), and the organoleptic rating 14.25. Besides, basing on formulation 21 developed by us, we have determined the content of minerals, in particular Ca, P, Mg, Fe, I2, in one portion.