title: Relationship between inflammatory markers, oxidant-antioxidant status and intima-media thickness in prepubertal children with juvenile idiopathic arthritis.
abstract: OBJECTIVE
  To investigate the presence of possible early atherosclerotic changes in a group of prepubertal children with juvenile idiopathic arthritis (JIA) and to establish the potential beneficial effects of 1-year treatment.
  
  
  METHODS
  Inflammatory markers (C-reactive protein, erythrocyte sedimentation rate), proinflammatory cytokines (IL-1β, IL-6, IFN-γ, TNF-α), lipid profile and oxidant-antioxidant status (urinary isoprostanes [PGF-2α]) were assessed in 38 JIA children (12M/26F, mean age 7.05 ± 2.39 years) and compared with 40 controls (18M/22F, mean age 6.34 ± 2.25 years). Carotid intima-media wall thickness (cIMT) was obtained and blood pressure was measured. All parameters were reassessed in JIA children after 1 year of therapy.
  
  
  RESULTS
  At baseline JIA children presented compared to controls higher levels of inflammatory markers, proinflammatory cytokines, total cholesterol, LDL cholesterol, and PGF-2α (all p ≤ 0.01). Furthermore, blood pressure and cIMT were significantly increased (both p ≤ 0.01). After a 1-year treatment with non-steroid anti-inflammatory (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs), a significant reduction of all parameters was detected (all p ≤ 0.01). This was associated with a significant reduction in blood pressure and cIMT (both p ≤ 0.01). Within the JIA group, patients requiring etanercept presented worse laboratory values and cIMT measurements at baseline. Nevertheless, the same improvement of all parameters was obtained after a 1-year treatment. In stepwise multiple regression, LDL cholesterol and IL-1β were mainly related to cIMT.
  
  
  CONCLUSIONS
  Chronic and systemic inflammation seems to lead to early atherosclerotic abnormalities even in pre-pubertal JIA children. Substantial improvement can be obtained with 1-year of appropriate therapy.
authors.affiliation: Department of Pediatrics, University of Chieti, Via dei Vestini 5, 66100, Chieti, Italy. luciana.breda@yahoo.it
authors.forename: L
authors.initials: L
authors.lastname: Breda
authors.forename: D
authors.initials: D
authors.lastname: Di Marzio
authors.forename: C
authors.initials: C
authors.lastname: Giannini
authors.forename: S
authors.initials: S
authors.lastname: Gaspari
authors.forename: M
authors.initials: M
authors.lastname: Nozzi
authors.forename: A
authors.initials: A
authors.lastname: Scarinci
authors.forename: F
authors.initials: F
authors.lastname: Chiarelli
authors.forename: A
authors.initials: A
authors.lastname: Mohn
mesh_terms: D000367:Age Factors; D000975:Antioxidants / Q000032:analysis*; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000097:blood / Q000150:complications* / Q000276:immunology / Q000628:therapy / Q000652:urine; D050197:Atherosclerosis / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000276:immunology / Q000628:therapy / Q000652:urine; D015415:Biomarkers / Q000097:blood / Q000652:urine; D001794:Blood Pressure; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D016014:Linear Models; D008055:Lipids / Q000097:blood; D008137:Longitudinal Studies; D008297:Male; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D046468:Sexual Development; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color
chemical_list: D000975:Antioxidants; D018501:Antirheumatic Agents; D015415:Biomarkers; D018836:Inflammation Mediators; D008055:Lipids