Feldman Debbie E, Vinet Évelyne, Bérard Anick, Duffy Ciarán, Hazel Beth, Meshefedjian Garbis, Sylvestre Marie-Pierre, Bernatsky Sasha
Université de Montréal and Centre de recherche interdisciplinaire en réadaptation de Montréal, Montreal, Canada.
McGill University Health Centre, Montreal, Canada.
Arthritis Care Res (Hoboken). 2017 Feb;69(2):306-309. doi: 10.1002/acr.22925.
To determine whether women with a history of juvenile arthritis are at higher risk for heart disease and hypertension and for developing adverse maternal outcomes: gestational diabetes mellitus, maternal hypertension, and preeclampsia/eclampsia.
We designed a nested case-control study from a cohort of first-time mothers with prior physician billing codes suggesting juvenile arthritis, and a matched comparison group without juvenile arthritis. For the nested case-control design, we selected 3 controls for each case for the outcomes of heart disease (n = 403), prepregnancy hypertension (n = 66), gestational diabetes mellitus (n = 285), maternal hypertension (n = 561), and preeclampsia/eclampsia (n = 236). We used conditional logistic regression, adjusting for maternal age and education.
Having juvenile arthritis was associated with heart disease (odds ratio [OR] 2.44 [95% confidence interval (95% CI) 1.15-5.15]) but not with gestational hypertension, diabetes mellitus, or preeclampsia/eclampsia. All 66 cases of prepregnancy hypertension had juvenile arthritis. Having prepregnancy hypertension was strongly associated with preeclampsia/eclampsia (OR 8.05 [95% CI 2.69-24.07]).
Women with a history of juvenile arthritis had a higher risk of heart disease. This risk signals the potential importance of cardiac prevention strategies in juvenile arthritis. As this was a retrospective study, it was not possible to correct for some relevant potential confounders. Further studies should assess the impact of medications, disease severity, and other factors (e.g., obesity) on cardiac outcomes in juvenile arthritis.
确定有幼年型关节炎病史的女性患心脏病和高血压以及出现不良孕产妇结局（妊娠期糖尿病、孕产妇高血压和子痫前期/子痫）的风险是否更高。
我们从一组首次生育且有医生开具的暗示幼年型关节炎的账单编码的母亲队列以及一个无幼年型关节炎的匹配对照组中设计了一项巢式病例对照研究。对于巢式病例对照设计，我们为心脏病（n = 403）、孕前高血压（n = 66）、妊娠期糖尿病（n = 285）、孕产妇高血压（n = 561）和子痫前期/子痫（n = 236）的结局为每个病例选择3名对照。我们使用条件逻辑回归，并对产妇年龄和教育程度进行了调整。
患有幼年型关节炎与心脏病相关（比值比[OR] 2.44 [95%置信区间(95%CI) 1.15 - 5.15]），但与妊娠期高血压、糖尿病或子痫前期/子痫无关。所有66例孕前高血压患者均患有幼年型关节炎。孕前高血压与子痫前期/子痫密切相关（OR 8.05 [95%CI 2.69 - 24.07]）。
有幼年型关节炎病史的女性患心脏病的风险更高。这种风险表明了心脏预防策略在幼年型关节炎中的潜在重要性。由于这是一项回顾性研究，无法对一些相关的潜在混杂因素进行校正。进一步的研究应评估药物、疾病严重程度和其他因素（如肥胖）对幼年型关节炎心脏结局的影响。
