Proceedings of the 26th European Paediatric Rheumatology Congress: part 2
M. C. Maggio, S. Giordano, H Voitova, M. Kastsianevich
Abstract
Introduction: Juvenile idiopathic arthritis (JIA) is a chronic immunoinflammatory joint disease with a high degree of disability and an unfavorable prognosis.In recent decades, drugs aimed at proinflammatory cytokines, such as tumor necrosis factor (TNF), have been used very often for the treatment of JIA.The effect of these drugs on metabolic processes is not well understood.Objectives: The aim of the study was to study metabolic disorders in children with JIA receiving biological therapy.Methods: 36 children with polyarticular JIA and 20 healthy children were examined in the rheumatology department of the 4th city children's clinical hospital in Minsk.All children with JIA have long received methotrexate, non-steroidal anti-inflammatory drugs and, if necessary, glucocorticoids.In connection with the preservation of a high degree of disease activity during therapy, patients were prescribed adalimumab.All children were determined by the main indicators of the lipid spectrum of the blood.Proteins that make up lipoproteins (apoproteins ApoA, ApoB, ApoE) were determined by the immunoturbidimetric method in the research laboratory of the Belarusian Medical Academy of Postgraduate Education.Statistical data processing was carried out by traditional methods of variation statistics on a personal computer using the program Statsoft Statistica 6.0.Results: In children with JIA, the use of adalimumab showed a significant (p <0.05) decrease in the concentration of ApoA (92.3 [69.7; 99.1] mg / dl) compared with the control group (127.2 [122.1;132.3] mg / dl) and an increase in ApoB (60.9 [48.9; 73.4] mg / dl) compared with the control group (32.1 [19.9; 50.8] mg / dl).The determination of ApoA and ApoB is used to calculate the ApoB / ApoA coefficient, which is a more reliable tool for assessing cardiovascular risk.With the ApoB / ApoA index <1, atherogenicity is regarded as low, with the ApoB / ApoA> 1, atherogenicity increases.ApoB / ApoA> 1 was established in 10 (27.8%) children with JIA.Apolipoprotein E (ApoE) plays an important role in the regulation of lipid metabolism, has a strong antiatherosclerotic effect.There is an assumption that apoE has allele-specific antioxidant abilities.The study found a reduced level of ApoE in the blood serum of children with JIA compared with the control group.During adalimumab treatment, a remission of the disease was achieved.According to the results of a second study of the indicators ApoA, ApoB and ApoE, 6 months after the start of biological therapy, an improvement in these indicators was found.Thus, the content of ApoA increased to 118.9 [113.2;129.4] mg / dL, and the ApoB content decreased to 33.6 [20.8; 49.4] mg / dl.An increase in ApoE to reference values was also noted. Conclusion:The results of the study indicate the likelihood of a reduction in cardiovascular risk in children with JIA in the treatment of adalimumab.