Dynamics of blood lipid spectrum indicators in children with juvenile idiopathic arthritis taking into account basic therapy

Abstract

Summary. In patients with rheumatoid arthritis, the risk of cardiovascular disease associated with atherosclerosis, is significantly increased compared to the general population. Studies of a cohort of children and young adults indicated that the atherosclerotic process usually begins long before its clinical manifestation, and the degree of vascular changes is associated with both the number of risk factors and their severity. The use of basic drugs in rheumatic patients contributed to a decrease in cardiovascular mortality, mainly due to the elimination of the activity of the process, which itself is an inducer of the onset and progression of atherosclerosis. The aim of the study was to establish the nature of changes in the blood lipid spectrum in children with juvenile idiopathic arthritis under the influence of basic therapy. Object and methods. We examined 85 children (8–18 years old) with juvenile idiopathic arthritis and oligo- (61.5 %) and polyarticular (38.5 %) variants of the disease, twice, with an interval of one year. The parameters of the blood lipid spectrum were determined by the level of: total cholesterol, triglycerides, high density lipoproteins, atherogenic coefficient by the enzymatic method on an automatic biochemical analyzer-photometer A25, low lipoproteins and very low density cholesterol by calculation method. Research results. Analysis of the lipid profile in the group as a whole showed that patients with juvenile idiopathic arthritis had significantly higher total cholesterol values (p < 0.05), a tendency to an increase in the level of triglycerides, low lipoproteins and very low density cholesterol, which led to an increase in the atherogenic coefficient level. When analyzing the lipid spectrum of blood after a year, a tendency towards a decrease in the level of atherogenic and an increase in antiatherogenic fractions of the lipid spectrum with normalization of atherogenic coefficient was noted. In the group of patients receiving monotherapy with methotrexate, no significant changes in the lipid spectrum of blood were observed after one year. Against the background of combined basic therapy, the blood lipid spectrum normalizes, namely, a decrease in total cholesterol, an increase in high density lipoproteins of cholesterol, a decrease in the level of low density cholesterol (p < 0.05), triglycerides and very low density cholesterol and, as a consequence, significant decrease in atherogenic coefficient (p < 0.01). Conclusions. The dynamics of changes in blood lipid spectrum indicators in children with juvenile idiopathic arthritis confirms the need to use combined basic therapy not only to control the activity of main pathological process, but also to prevent the development of atherogenic dyslipoproteinemias.