Juvenile idiopathic arthritis linked to altered HDL functionality

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Takeaway

  • The presence of juvenile idiopathis arthritis (JIA) is associated with alterations in HDL particle distribution, cholesterol efflux and non-lipid transporting activities, which have implications for cardiovascular risk,

Study design

  • Prospective cross-sectional matched characteristic study of 44 patients, comprising 29 adolescents and young adults with JIA and 15 controls.
  • The disease group were aged 10-35 years.

Key results

  • JIA patients demonstrated lower levels of HDL cholesterol [47.0 (40.0, 56.0) vs. 56.0 (53.0, 61.0) mg/dL, P=0.04], total HDL [29.5 (27.9, 32.3) vs. 32.9 (31.6, 36.3) mg/dL, P=0.05] and large HDL [5.1 (3.7, 7.3) vs. 8.0 (6.7, 9.7) mg/dL, P=0.04] particles.
  • JIA patients demonstrated greater cholesterol efflux mediated via ATP binding cassette A1 (ABCA1) [17.3% (12.8, 19.7) vs. 10.0% (5.8, 16.0), P=0.05] and less efflux mediated via ATP binding cassette G-1 (ABCG1) [3.2% (2.0, 3.9) vs. 4.8% (3.5, 5.8), P=0.01] and SR-B1 [6.9% (6.0, 8.4) vs. 9.1% (8.6, 10.2), P=0.002] compared with controls.
  • Exposing macrophages to serum from JIA patients resulted in a smaller increase in mRNA expression of ABCA1 (2.0±0.95 vs. 7.1±5.7 fold increase, P=0.01) and greater increases in expression of ABCG1 [1.4 (0.9, 1.5) vs. 0.8 (0.7, 1.1) fold increase, P=0.04] and SR-B1 (1.3±0.47 vs. 0.7±0.3 fold increase, P=0.001) compared with controls. 
  • No differences in cIMT were observed between JIA patients and controls.
Limitations
  • Conducted in a small cohort and the study design did not allow for longitudinal follow-up to determine effects of these changes in HDL functionality on clinical outcomes.

Why This Matters
  • These abnormalities could translate to subclinical atherosclerosis and cardiovascular risk, and whether they identify an individual who requires more aggressive cardiovascular risk modification or if they respond to intensification of anti-inflammatory therapy should be examined in future and larger cohorts.