Women who have juvenile idiopathic arthritis (JIA) – an umbrella term for several types of arthritis that develop in childhood appear to be at higher risk of developing heart disease than women who do not have inflammatory arthritis, according to a new study out of Canada. For years, researchers have examined the link between inflammatory forms of arthritis, such as rheumatoid arthritis (RA) or lupus, and an increased risk of heart disease. But no one had studied heart health in adults with JIA (another inflammatory form of arthritis), and little was known about the health effects of lifelong JIA during pregnancy.
To fill this gap, researchers at the University of Montreal, Canada, used physician and hospital databases to identify women who were diagnosed with JIA at age 16 or younger and gave birth for the first time between 1985 and 2010. Each of the 1,681 women with JIA in the study was matched with four women without the disease who were similar in age, place of residence and delivery date.
In addition to looking at heart disease – broadly defined as including coronary artery disease (a narrowing of the arteries that feed the heart), heart valve problems, heart failure and acute rheumatic fever – the researchers looked at rates of pre-pregnancy high blood pressure (hypertension) and at problems that can develop during pregnancy, such as gestational diabetes, pregnancy-related hypertension and preeclampsia (a potentially life-threatening spike in blood pressure).
After taking into account factors such as the women’s age and education level, the team found that women with JIA were more than twice as likely to have been diagnosed with heart disease as were women without JIA. They also found that all of the instances of pre-pregnancy hypertension occurred in women with JIA. However, they did not find an association between JIA and complications during pregnancy, specifically gestational diabetes, preeclampsia or pregnancy-related hypertension.
Lead study author Debbie Feldman, PhD, a professor at the University of Montreal and a physical therapist, says the high rate of heart disease might be the result of a lack of physical activity, the damaging effects of chronic inflammation on blood vessels, medications or some combination of all three. She says the study highlights the importance of monitoring and improving blood pressure and heart health in young adults with JIA.
“Encouraging physical activity is extremely important [because] youth with JIA are less physically active. Prevention strategies should also include advice on heart-healthy diets and discouraging smoking. I believe this should be started as soon as possible following diagnosis or at the very least in adolescence,” she says.
Feldman acknowledges that the nature of the study made it impossible to take into account other factors that might play a role in heart disease, such as obesity, smoking and diet. And although her team used database information, the number of people included in the study was relatively small, which can affect statistical results.
Egla Rabinovich, MD, co-chair of the department of pediatric rheumatology at Duke University in Durham, North Carolina, says the study has other limitations. For instance, JIA is not one disease but rather a group of at least six diseases, all very different from one another (and from RA). But the researchers did not look at the subtypes of JIA, instead treating them as a single condition. Dr. Rabinovich, who was not involved in the study, also points out that during the nearly half century the research covered (some of the women in the study may have been born in the 1960s or earlier), treatments for JIA changed dramatically, which might have had an effect on the cardiovascular health outcomes found in the study.
“While these results are intriguing, there really needs to be further study into the association between heart disease [and] JIA, with better definitions of heart disease and the study population,” she says. “Certainly, those taking care of women with a history of JIA should look at risk factors for heart disease, such as hypertension, lipid profiles, obesity and smoking, and modify risk factors, as one would for all patients.”
Author: Linda Rath for the Arthritis Foundation