Abstract
ObjectiveDyslipidemia with higher inflammatory states, disease activity, and longer disease duration in juvenile idiopathic arthritis (JIA) patients seemed to increase the risks of atherosclerosis. Tumor necrosis factor- α (TNF-α) receptor blocking agent etanercept has been proven to be effective in JIA. However, data about the correlation of anti-inflammatory treatment on lipid profiles and atherogenic index in JIA patients remains limited. This study aimed to investigate the longitudinal changes on lipid profiles and atherogenic index in JIA patients after etanercept treatment.MethodsTwenty-three patients diagnosed with JIA (polyarticular type n = 7; oligoarticular type, n = 2; systemic type, n = 10, Enthesitis-related arthritis = 4) received treatment with etanercept during the period 2004–012 in a medical center. We measured their serum lipid profiles at baseline and 2, 4, 6, 12 months later, and determined whether there were differences in complete blood counts, inflammatory mediators, lipid levels and atherogenic indices between patients who had inactive disease (responders) and those who were poor responders (non-responders) to etanercept treatment.ResultsAnalysis of dynamic change in total JIA patients before and after TNF inhibitor therapy showed modest increases in hemoglobin levels (P = 0.02) and decreases in WBC counts, Platelet and CRP levels progressively (p = 0.002, p = 0.006 and p = 0.006, respectively).Twelve of the 23 patients achieved inactive disease status (responders) after 12-months of treatment. In responders, compared to non-responders, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) increased significantly (P = 0.007,P = 0.044,P<0.001), whereas triglyceride and atherogenic index (TC/HDL-C ratio) significantly decreased (P = 0.04, P = 0.01, respectively) after etanercept treatment.ConclusionDisease severity was associated with triglyceride level, atherogenic index and was inversely associated with total cholesterol, HDL-C, and LDL-C levels and can be improved substantially by using anti TNF-α treatment. Such treatment may have a beneficial effect on the cardiovascular risk in patients with JIA.
Highlights
Chronic inflammatory diseases such as rheumatoid arthritis, systemic lupus erythematosus had been proven to have a higher risk of premature coronary artery disease [1]
Disease severity was associated with triglyceride level, atherogenic index and was inversely associated with total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels and can be improved substantially by using anti tumor necrosis factor-alpha (TNF-a) treatment
In adult patients with rheumatoid arthritis, cardiovascular disease is the leading cause of shortened life expectancy relative to the general population, and nearly half of these deaths can be attributed to cardiovascular disease that is linked to inflammation and elevated C-reactive protein (CRP) levels [4]
Summary
Chronic inflammatory diseases such as rheumatoid arthritis, systemic lupus erythematosus had been proven to have a higher risk of premature coronary artery disease [1]. Non-steroidal anti-inflammatory drug, methotrexate and glucocorticoid are the standard and first line treatment regimen for JIA [9] Such traditional therapy is not always effective and has unknown toxic side effects. Etanercept, is a soluble fusion protein comprised of the extracellular domain of the TNF receptor (p75) and Fc portion of human immunoglobulin G1, and is the drug of choice for disease-modifying antirheumatic drugs refractory RA [10,11]. It has a beneficial effect in patients with JIA that had previously had no response or were refractory to conventional therapy [12,13]
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