How juvenile arthritis may increase future heart disease risk – what families need to know
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Although arthritis is often viewed as a condition that primarily affects older adults, juvenile idiopathic arthritis (JIA) represents a significant autoimmune‑mediated form of arthritis in children. In the United States, JIA is diagnosed in approximately 1 in every 1,000 children aged 16 or younger, underscoring that chronic inflammatory joint disease is not limited to adulthood.
The term idiopathic means that the disease arises spontaneously and the definitive cause is unknown or poorly understood. It is the most common form of arthritis in children, causing joint swelling, pain, and stiffness, and in some cases eye inflammation (uveitis).
There are several subtypes of the disease, including:
- Oligoarticular JIA: This is the most common type of JIA. It affects four or fewer joints, usually the larger joints such as knees and ankles. Girls are diagnosed with this condition more often than boys.
- Polyarticular JIA: This form of JIA affects five or more joints, both large joints and smaller ones such as fingers. Polyarticular JIA is further divided into two subgroups based on whether the child tests positive or negative on a rheumatoid factor antibody test.
- Systemic JIA or Still’s disease: Systemic JIA is rare and affects not only the joints, but the entire body. The inflammation caused by the disease can cause rashes, fevers, and damage to organs including the heart, liver, and spleen.
- Enthesitis-related arthritis: This form of JIA mainly affects boys. It causes not only joint swelling and pain, but also inflammation where ligaments and tendons attach to bone. It primarily affects the lower extremities and the spine.
- Juvenile psoriatic arthritis: Juvenile psoriatic arthritis is rare. In addition to causing joint inflammation and pain, it also causes psoriasis.
With treatment, which can include nonsteroidal anti-inflammatory medicines (NSAIDs) to reduce pain and inflammation, disease-modifying antirheumatic medicines (DMARDs)—such as methotrexate, corticosteroids, and biologics—as well as physical and occupational therapy, up to 70% of children with JIA go into remission.
JIA and the future risk of heart disease
For people who are in remission from JIA and those who still experience symptoms and take medications to control the impact of the disease in adulthood, some studies have found an increase in the risk of developing a range of cardiovascular conditions, including:
- High blood pressure
- Subclinical heart failure (an asymptomatic stage of heart disease characterized by structural heart changes or elevated biomarkers without overt symptoms)
- Early buildup of plaque in the arteries
- High cholesterol levels
All of these conditions can raise the risk of heart attack, heart failure, heart valve problems, and stroke.
There are a number of underlying factors that are associated with an increase in cardiovascular disease risk in people who have been diagnosed with JIA. This autoimmune disease causes inflammation throughout the body. A number of studies found increases in C-reactive protein, a protein produced by the liver that increases in the blood as the level of inflammation in the body rises, and pro-inflammatory cytokines (signaling proteins released by immune cells to initiate, heighten, and manage the body’s inflammatory response), adipokines (adipose-derived signaling proteins that mediate obesity-related inflammation and cardiovascular disease), and endothelial activation markers (molecules released by endothelial cells during inflammation). These increases were found in both adults with active JIA as well as those who were in clinical remission.
The medications that are prescribed to treat JIA and manage symptoms are also associated with an increase in cardiovascular risk. Long term use of NSAIDs can increase the risk of heart attack, heart failure, and stroke. In fact, all non-aspirin NSAIDs carry an FDA warning for an increased risk of serious, potentially fatal cardiovascular thrombotic events, including heart attack and stroke.
The situation surrounding disease-modifying antirheumatic medicines (DMARDs) is more nuanced. Methotrexate has been found to be cardioprotective, reducing inflammation that can increase cardiovascular risk. The evidence of cardioprotection with other DMARDs is less consistent and needs additional study. Corticosteroids reduce inflammation, but can increase blood pressure, cholesterol levels, and the risk of atherosclerosis.
JAK inhibitors, including tofacitinib (Xeljanz), baricitinib (Olumiant), and upadacitinib (Rinvoq), have been associated in some studies with an increased risk of heart attack, stroke, blood clots, and death. However, other studies found no increased risk with short term use of these medications.
Other factors that are associated with an increased risk of heart disease for people diagnosed with JIA include physical inactivity due to joint pain, which can lead to being overweight or obese. Inactivity and weight gain can have a cascading effect on cardiovascular health, increasing the risk of high blood pressure, cholesterol, and blood sugar. Depression and chronic stress, which people with a chronic illness like JIA may experience, have also been associated with an increased risk of developing heart disease.
Strategies to lower your cardiovascular risk
If you were diagnosed with JIA as a child or are still living with autoimmune arthritis, there are several strategies that can help you manage and reduce your risk of developing heart disease as an adult. These include:
- Having your primary care physician, rheumatologist, or cardiologist regularly monitor and treat heart disease indicators such as cholesterol, blood sugar, and blood pressure
- Taking the lowest effective dose of medications to manage JIA under your physician’s guidance
- Being as active as possible (talk with your physician or a physical therapist to learn which exercises are safe and effective based on your mobility and level of joint discomfort)
- Reaching and maintaining a healthy weight by eating a heart-healthy diet
- Not smoking (smoking can increase inflammation and its related symptoms, make some arthritis medications less effective, and increase the risk of heart disease)
- Managing stress and mental health by seeking the care of a mental health professional and using stress mitigation techniques like meditation, breathing exercises, and movement-based practices like yoga and tai chi
Connect with PinnacleCare
For more information about how PinnacleCare’s Health Advisors could assist you with juvenile arthritis and/or heart disease support, connect with us today.
Juvenile Idiopathic Arthritis and Heart Disease Risk: Top 3 FAQs for Families
These quick FAQs explain the possible link between juvenile idiopathic arthritis (JIA) and heart disease risk in adulthood—and what families can do now to protect long-term health.
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