Lipid Profiles Alter from Pro-Atherogenic into Less Atherogenic and Proinflammatory in Juvenile Idiopathic Arthritis Patients Responding to Anti TNF-α Treatment

Objective: Dyslipidemia with higher inflammatory states, disease activity, and longer disease duration in juvenile idiopathic arthritis (JIA) patients seemed to increase the risks of atherosclerosis. Tumor necrosis factor-alpha (TNF-alpha) receptor blocking agent etanercept has been proven to be effective in JIA. However, data about the correlation of anti-inflammatory treatment on lipid profiles and atherogenic index in JIA patients remains limited. This study aimed to investigate the longitudinal changes on lipid profiles and atherogenic index in JIA patients after etanercept treatment. Methods: Twenty-three patients diagnosed with JIA (polyarticular type n = 7; oligoarticular type, n = 2; systemic type, n = 10, Enthesitis-related arthritis = 4) received treatment with etanercept during the period 2004-012 in a medical center. We measured their serum lipid profiles at baseline and 2, 4, 6, 12 months later, and determined whether there were differences in complete blood counts, inflammatory mediators, lipid levels and atherogenic indices between patients who had inactive disease (responders) and those who were poor responders (non-responders) to etanercept treatment. Results: Analysis of dynamic change in total JIA patients before and after TNF inhibitor therapy showed modest increases in hemoglobin levels (P = 0.02) and decreases in WBC counts, Platelet and CRP levels progressively (p = 0.002, p = 0.006 and p = 0.006, respectively). Twelve of the 23 patients achieved inactive disease status (responders) after 12-months of treatment. In responders, compared to non-responders, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) increased significantly (P = 0.007, P = 0.044, P<0.001), whereas triglyceride and atherogenic index (TC/HDL-C ratio) significantly decreased (P = 0.04, P = 0.01, respectively) after etanercept treatment. Conclusion: Disease severity was associated with triglyceride level, atherogenic index and was inversely associated with total cholesterol, HDL-C, and LDL-C levels and can be improved substantially by using anti TNF-alpha treatment. Such treatment may have a beneficial effect on the cardiovascular risk in patients with JIA.