Moms with Juvenile Arthritis at Risk of Heart Disease

Pregnant women with juvenile arthritis are at heightened risk of heart disease, new research finds.

A nested case-control study of first-time mothers from Quebec, Canada revealed that women with juvenile arthritis were more than twice as likely than those without the disease to have a heart disease diagnosis (adjusted OR 2.44, 1.15-5.15, CI: 95 percent). Of the 1,681 mothers with juvenile idiopathic arthritis included in the study, 403 had heart disease.

There are few studies on the cardiovascular risks of juvenile arthritis, wrote study researcher Debbie Feldman of the University of Montreal and her colleagues. A 2015 study in Annals of the Rheumatic Diseasesfound increased systolic and diastolic blood pressure in adults with juvenile idiopathic arthritis compared with controls, as well as increased pulse wave velocity. A 2013 paper in Rheumatologyargued for more attention on cardiovascular risk in juvenile arthritis. At least a third of adults with JIA have active disease, the researchers wrote, and chronic inflammation is known to increase the risk of cardiovascular issues in other diseases, such as rheumatoid arthritis.

"Since sustained systemic inflammation is known to accelerate atherosclerosis, individuals with JIA and in particular those with persistent inflammation may be at increased risk of CVD," the researchers wrote. They cited several studies finding that children with juvenile arthritis often have elevated blood pressure and research suggesting that biomarkers of cardiovascular disease may also be elevated in at least some young juvenile arthritis patients. However, there was a "paucity of data" regarding cardiovascular risk in the disease, the researchers wrote, and very little study of patients into adulthood.

In that sense, the paper on expectant mothers in Quebec starts to fill an important gap. Researchers used billing data to identify 1,681 patients diagnosed with juvenile arthritis between 1983 and 2010 who also gave birth for the first time in that time period. They then matched each case with four first-time moms without juvenile arthritis who were within five years of age of the case and lived within the same region (n=6,724).

Among the juvenile arthritis cases, 403 had a heart disease diagnosis, 66 had pre-pregnancy hypertension, 561 had maternal hypertension, 285 had gestational diabetes and 236 had pre-eclampsia or eclampsia. The researchers matched three controls per each of these cases from the original cohort. They controlled for maternal education, maternal deprivation and age.

Heart disease was the only condition significantly associated with juvenile idiopathic arthritis. Of the heart disease patients with JIA, 1.7 percent had acute rheumatic fever, 4 percent had chronic rheumatic fever, 7.4 percent had pulmonary circulation disorders, 38.2 percent had ischemic heart disease and 48.6 percent had some other heart condition. In addition, everyone in the sample who had pre-pregnancy hypertension also had juvenile arthritis.

Though billing data has drawbacks, including lack of validation and information on disease severity, the results suggest that young adults with juvenile idiopathic arthritis are at heightened heart disease risk, the researchers wrote in Arthritis Care & Research.

"Possible explanations include factors that are associated with both certain types of heart disease and JIA such as lower physical activity, inflammation, and medications," they wrote. "Monitoring and treating high blood pressure in young adults with JIA may be important. Other prevention strategies may also be warranted, including advice on diet, promotion of physical activity and discouraging smoking."

References:

1. Feldman DE, Vinet É, Bérard A, et al. Heart Disease, hypertension, gestational diabetes and pre-eclampsia/eclampsia in mothers with juvenile arthritis: A nested case-control study. Arthritis Care & Research 2016. doi:10.1002/acr.22925.
2. Aulie HA, Selvaag AM, Günther A, et al. Arterial haemodynamics and coronary artery calcification in adult patients with juvenile idiopathic arthritis. Annals of the Rheumatic Diseases Ann Rheum Dis 2014;74(8):1515–1521. doi:10.1136/annrheumdis-2013-204804.
3. Coulson EJ, Ng W-F, Goff I, Foster HE. Cardiovascular risk in juvenile idiopathic arthritis. Rheumatology 2013;52(7):1163–1171. doi:10.1093/rheumatology/ket106.