A95: The Risk of Dyslipidemia in Pediatric Arthritis Patients Is Similar to That of Adult Patients With Arthritis. Issue 11 (March 2014) - Hayes, Timothy
Abstract : Background/Purpose: Patients with autoimmune diseases run a higher risk for dyslipidemia due to chronic inflammatory processes and immune dysregulation. This phenomenon has been recognized to a certain extent in adult arthritis patients but has not been previously explored in pediatric arthritis patients. The objective of this study is to compare the frequency of dyslipidemia in children with Juvenile Rheumatoid Arthritis (JRA), children with Non‐Specific Arthritis (NOSA), adults with Rheumatoid Arthritis (RA), and adults with Osteoarthritis (OA). Determining differences amongst these groups is important in understanding the connection between arthritis and dyslipidemia risk, especially in the pediatric population. Methods: After IRB approval, patient's in this retrospective data base study were gathered from chart review of consecutive patient's with JRA, NOSA, RA, and OA who presented to the pediatric rheumatology and adult rheumatology clinics at an academic center. Outcomes of interest that were compared included total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides (TG), cholesterol: HDL ratio, non‐HDL, and very low density lipoprotein (VLDL). Other demographic information compared included patient age, sex, and use of biologic DMARD. Comparisons between groups were made using the Fisher's Exact Test and multiple testing adjustments were made by controlling for the False Discovery Rate. Results: There were 32 pediatric patients (40.6% male) ranging from age 2–17 (median 11 years). Out of 32 pediatric patients, 22 had JRA and 10 had non‐ specific arthritis (NOSA). Furthermore, there were 82 adult patient's (18.3% male) ranging from age 30–85 (median 63 years). Out of these, 49 had diagnosis of RA while 33 had diagnosis of OA. In the pediatric cohort, more JRA patients than NOSA had abnormal LDL values (68.2% and 0.0%, p value = 0.005) and non‐HDL values (50.0% and 0.0%, p value = 0.05). Other lipid parameters were not significantly different. Between the pediatric cohort and adult cohort, the pediatric cohort had greater percentages of abnormal LDL (46.9% and 19.5%, p value = 0.05), TG (93.8% and 24.4%, p value <0.001), and VLDL (62.5% and 15.9%, p value <0.001). No significant difference in lipid parameters between patients with RA and OA. There was also no significant difference in lipid parameters between those with or without RF/CCP positivity, male sex, or biologic DMARD use. Conclusion: Pediatric JRA patients were more likely to have an abnormal lipid panel, specifically LDL and non–HDL, as compared to NOSA patients. Interestingly, pediatric patients had higher rates of abnormal LDL, triglycerides, and VLDL. This suggests that the concern for dyslipidemia in the adult population should also be shown to pediatric patients with JRA. Additional studies are needed to determine whether modification of cardiovascular risk in pediatric patients with chronic inflammatory disease is beneficial in preventing clinically significant premature atherosclerosis.