Abstract
BackgroundVascular health is of concern in patients with Juvenile Idiopathic Arthritis (JIA) since Rheumatoid Arthritis (RA) epidemiologically has a well-described association with premature development of atherosclerosis. Chronic inflammation with persisting systemic circulating inflammatory proteins may be a cause of vascular damage, but general physical inactivity could be an important contributor. Pain and fatigue are common complaints in patients with JIA and may well lead to an inactive sedentary lifestyle. For this reason we assessed the physical activity (PA) objectively in patients with moderate to severe Juvenile Idiopathic Arthritis (JIA) in comparison with gender and age matched healthy schoolchildren, and looked for associations between PA and features of JIA.MethodsOne hundred thirty-three patients, 7–20 years of age, participated. Disease activity, disability, functional ability, and pain were assessed and PA was measured by accelerometry through 7 days and compared to PA in age- and gender-matched healthy schoolchildren.ResultsWe found a significantly lower level of PA in patients compared to gender- and age-matched healthy schoolchildren both in average activity (counts per minute, cpm) (475.6 vs. 522.7, p = 0.0000018) and in minutes per day spent with cpm >1500 (67.9 vs. 76.4, p = 0.0000014), with cpm >2000 (moderate physical activity) (48.4 vs. 52.8, p = 0.0001, and with cpm >3000 (high physical activity) (24.7 vs. 26.5, p = 0.00015). A negative association (β = −0.213, p = 0.014) between active disease in weight bearing joints and high physical activity remained the only significant association between disease related factors and PA. Of the girls 19 % and of the boys 45 % (vs. 39 % and 61 % in the reference group) met standards set by Danish Health Authorities for daily PA in childhood.ConclusionChildren and adolescents with JIA are less physically active than their healthy peers and less active than recommended for general health by the Danish Health Authorities. This is not explained by pain or objective signs of inflammation. When inflammation has been curbed, restoration of an active healthy lifestyle should be highly prioritized.
Highlights
Vascular health is of concern in patients with Juvenile Idiopathic Arthritis (JIA) since Rheumatoid Arthritis (RA) epidemiologically has a well-described association with premature development of atherosclerosis
Chronic inflammation with persisting systemic circulating inflammatory proteins could be a cause of vascular damage, but general physical inactivity in childhood is associated with well-known risk factors for premature development of cardiovascular disease [8] and could be an important contributor
The inclusion criteria were fulfilled by 260 patients, 50 patients refused to participate and 44 accepted clinical examination and blood tests but declined accelerometer monitoring. 166 patients accepted to participate fully but only 133 returned satisfactory accelerometer measurements for assessment of physical activity
Summary
Vascular health is of concern in patients with Juvenile Idiopathic Arthritis (JIA) since Rheumatoid Arthritis (RA) epidemiologically has a well-described association with premature development of atherosclerosis. Chronic inflammation with persisting systemic circulating inflammatory proteins may be a cause of vascular damage, but general physical inactivity could be an important contributor. Rheumatoid Arthritis (RA) is epidemiologically associated with premature development of cardiovascular disease (CVD) and shortened lifespan This has led to investigations of the vascular health in patients with JIA; one finds arterial endothelial thickening, a preclinical sign of atherosclerosis that may develop into accelerated clinically important arteriosclerosis in adulthood [5,6,7]. Chronic inflammation with persisting systemic circulating inflammatory proteins could be a cause of vascular damage, but general physical inactivity in childhood is associated with well-known risk factors for premature development of cardiovascular disease [8] and could be an important contributor. Pain and fatigue are common complaints in patients with JIA and may well lead to an inactive lifestyle
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