Assessment of Subclinical Atherosclerosis Markers and Their Relationship With Disease Activity in Juvenile Idiopathic Arthritis.

BACKGROUND

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children. Although primarily affecting the joints, the prolonged inflammatory process characteristic of this chronic condition may also contribute to early-onset atherosclerosis. This study aimed to evaluate early markers of atherosclerosis in patients with JIA and to investigate their association with disease activity.

METHODS

This cross-sectional study was conducted between March and September 2025 and included patients under 16 years of age diagnosed with JIA. The healthy control group consisted of age-matched and sex-matched children. Disease activity was assessed using the Juvenile Arthritis Disease Activity Score (JADAS-27). Epicardial adipose tissue thickness (EATT) and carotid intima-media thickness (CIMT) were measured.

RESULTS

A total of 48 children diagnosed with JIA (43.8% male, mean age 12.6±4.1 y) and 25 age-matched, BMI-matched, and sex-matched healthy controls (44.0% male, mean age 12.7±3.8 y) were included. Twenty-three (48%) of the patients had oligo-JIA, 11 (23%) had RF (-) poly-JIA, and 9 (19%) had enthesitis-related JIA. Patients with JIA showed significantly lower mitral E waves and higher right and left CIMT and eEATT than healthy controls ( p <0.01). EATT positively correlated with age, JADAS-27 score, and CIMT ( p <0.001). An EATT cutoff >3.15 mm predicted high disease activity (JADAS-27 >25) with 71.4% sensitivity and 60% specificity (AUC=0.77, p <0.001). Multiple regression analysis identified EATT >3.15 mm as an independent predictor of high disease activity (β=2.37, 95% CI: 0.52-4.22, p =0.01).

CONCLUSIONS

This study demonstrated that both EATT and CIMT were elevated in JIA patients compared with healthy controls, and that increased EATT independently predicted higher disease activity. Clinicians managing JIA patients with high disease activity should be aware of the potential presence of atherosclerosis.