Determining Vascular Risk Profiles for Early Atherosclerosis in Paediatric Rheumatic Disease

  • Dr Timothy Bradley, The Hospital for Sick Children, Canada
  • Mr Pascal Tyrrell, The Hospital for Sick Children, Canada
  • Mr Lawrence Ng, The Hospital for Sick Children, Canada
  • Mr Cameron Slorach, The Hospital for Sick Children, Canada
  • Mr Joseph Beyene, The Hospital for Sick Children, Canada
  • Dr Rayfel Schneider, The Hospital for Sick Children, Canada
  • Dr Brian Feldman, The Hospital for Sick Children, Canada
  • Dr Earl Silverman, The Hospital for Sick Children

    • Objectives: Increased rates of atherosclerotic disease in adults with Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis have not been explained by exposure to traditional cardiovascular risk factors alone, prompting investigation into the role of chronic inflammation. The aims of this study were to determine and compare the prevalence of early vascular markers of atherosclerosis in children with SLE, Systemic Juvenile Inflammatory Arthritis (SJIA) and Juvenile Dermatomyositis (JDM).
    Methods: Vascular indices, including carotid intima-media thickness (CIMT), flow-mediated dilatation (FMD) and pulse wave velocity (PWV), were compared within groups to normal population data and between groups using parametric methods.
    Results: Of the 101 SLE (age 15.2±2.6 years, M:F=18:83), 16 SJIA (age 13.4±2.6 years, M:F=6:10) and 24 JDM (age 13.4±2.6 years, M:F=14:10), SLE were older and more predominantly female. Mean CIMT were lower in SLE and SJIA compared to controls (both P<0.001), but no different between groups (SLE 0.40±0.05 vs. SJIA 0.38±0.06 vs. JDM 0.42±0.07 mm). Mean FMD response was lower in SLE compared to controls (P<0.001), but no different between groups (SLE 8.2±4.3 vs. SJIA 8.0±3.4 vs. JDM 8.2±3.5 %). Mean PWV were higher in SLE and JDM compared to controls (both P<0.01), but not significantly different between the groups (SLE 4.6±1.5 vs. SJIA 4.5±2.3 vs. JDM 4.0±0.8 m/s).
    Conclusions: Risk profiles for early vascular markers of atherosclerosis differ according to the underlying paediatric rheumatic disease process. Disease activity, therapy-related and disease-specific inflammatory factors are likely playing a role in modifying these cardiovascular risk profiles and warrant further investigation.