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Activation of the haemostatic system in children with juvenile rheumatoid arthritis correlates with disease activity
S Gallistl1, H Mangge, G Neuwirth
1Department of Paediatrics and Ludwig Boltzmann Institute for Paediatric Haemostasis and Thrombosis, University of Graz, Austria. Siegfried.gallistl@kfunigraz.ac.at
Insights
Juvenile rheumatoid arthritis (JRA) in children shows subclinical blood clotting activation. Markers like Prothrombin fragment 1+2 (F1+2) and thrombin-antithrombin complex (TAT) correlate with disease activity.
Area of Science:
- Pediatric Rheumatology
- Hemostasis and Thrombosis
- Immunology
Background:
- Juvenile rheumatoid arthritis (JRA) is a chronic inflammatory condition in children.
- Understanding the hemostatic system's role in JRA is crucial for disease management.
- Subclinical activation of coagulation may contribute to JRA pathogenesis.
Purpose of the Study:
- To investigate markers of blood coagulation and fibrinolytic activity in children with JRA.
- To compare these markers with those in children with postinfectious arthropathies and healthy controls.
- To assess the correlation between hemostatic markers and clinical disease activity in JRA.
Main Methods:
- Solid-phase enzyme-linked immunosorbent assays (ELISA) were used to measure Prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT), and D-Dimer.
- Measurements were performed in 24 children with JRA and 10 with postinfectious arthropathies.
- Results were correlated with clinical parameters like joint index score and C-reactive protein (CRP).
Main Results:
- F1+2, TAT, D-Dimer, and fibrinogen levels were significantly elevated in children with JRA compared to controls.
- These elevated markers correlated significantly with disease activity indices (joint score, CRP).
- A subclinical activation of the hemostatic system was demonstrated in JRA patients.
Conclusions:
- Children with JRA exhibit subclinical activation of the hemostatic system.
- This activation is linked to disease activity and may involve immunomediator effects on monocytes and endothelial cells.
- Further research into the interplay between inflammation and coagulation in JRA is warranted.
Abstract:
Twenty-four children with juvenile rheumatoid arthritis (JRA) and 10 children with postinfectious arthropathies were investigated for markers of blood coagulation and fibrinolytic activity: Prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT), and D-Dimer were measured using solid phase enzyme linked immunosorbent assays (ELISA). Results were compared with clinical and conventional laboratory signs of disease activity. F1+2, TAT, D-Dimer, and fibrinogen were significantly elevated in children with JRA as compared with healthy children and children with postinfectious arthropathies. F1+2, TAT, and D-Dimer correlated significantly with disease activity, assessed by determination of the joint index score and C-reactive protein (CRP). The study demonstrates a subclinical activation of the haemostatic system in children with JRA correlating with disease activity, which might be caused by the action of several immunomediators on cells (monocytes, endothelial cells) playing a role in the regulation of blood coagulation activity.