Dyslipidemia in active juvenile dermatomyositis patients

Abstract

Background: Juvenile dermatomyositis (JDM) patients may present many risk factors for dyslipidemia such as chronic inflammation and corticosteroid therapy. To our knowledge, the concomitant evaluation of lipid profile, anti-lipoprotein lipase antibody (anti-LPL), clinical and laboratory assessments, and treatment have not been performed. Aim: To evaluate dyslipidemia in JDM patients and healthy controls. Methods: 25 JDM patients followed at the Pediatric Rheumatology Unit of our tertiary University Hospital were compared to 25 healthy controls according to demographic data, fasting lipoproteins, glycemia and insulin, anti-LPL antibodies and muscle enzymes. All patients were evaluated by the same pediatric rheumatologist in order to evaluate the following JDM scores: Disease Activity Score(DAS), Childhood Myositis Assessment Scale(CMAS), Manual Muscle Testing(MMT), Myositis Disease Activity Assessment Analogue Scale(MYOACT) and Myositis Intention To Treat Activity Index (MYTAX). Results: The mean current age of JDM was similar to controls (138.6 ±45.96 vs. 134±31 months, p=0.7), likewise the female gender (56% vs. 52%, p=0.5). Abnormal lipid profile was observed in 9 patients(36%) and 4(16%) controls, p=0.196. Of these JDM patients: low HDL levels were found in seven(28%), high triglycerides in four (TG)(16%), high total cholesterol in three(12%) and high LDL in one(4%). Lipodystrophy was observed in only one JDM patients with dyslipidemia. JDM patients presented higher levels of VLDL (16vs.13mg/dl,p=0.02), triglycerides (80vs.61mg/dl,p=0.011), fast insulin (8vs.3.9μU/ml,p=0.01), and lower glucose/insulin rate (8.8vs.19.7,p=0.004) compared to controls. JDM with dyslipidemia had higher AST levels(32 vs 24,5U/L, p=0,044), ESR (26vs14.5mm/1st hour,p=0.006) and CRP (2.1vs0.4mg/dl,p=0.006) compared with patients with normal lipid profile. In addition, this group also had higher scores of DAS(6vs.2,p=0.008), MYOACT(0.13vs.0.01, p=0.012), MYTAX(0.06vs.0,p=0.018), and lower scores of CMAS(47vs.52, p=0.024) and MMT(78vs.80,p=0.001) compared to JDM without dyslipidemia. Positive correlations were detected between TG levels and CRP(r=0.697,p=0.001), DAS(r=0.610,p=0.001), MYOACT(r=0.661,p=0.001), MYTAX(r=0.511,p=0.008), and negative correlations between TG and CMAS(r=-0.506,p=0.009) and MMT(r=-0.535,p=0.005). Furthermore, positive correlations were found between LDL and DAS(r=0.425,p=0,034), MYOACT (r=0.534,p=0,006), MYTAX (r=0.415,p=0.039) and negative correlation with CMAS(r=-0.48,p=0,0248). However, no differences were found between JDM with and without dyslipidemia regarding body mass index, lipodystrophy, anti-LPL antibodies, and treatment (current and cumulative doses of prednisone, methotrexate and cyclosporine) (p>0.05). Conclusions: Dyslipidemia was observed in active JDM patients, suggesting that adequate disease control and individualized use of lipid-lowering agents may lower the risk of premature atherosclerosis in these patients.