Juvenil İdiopatik Artritli Hastalarda Metabolik Sendrom Durumunun Değerlendirilmesi

Öz

Amaç: Çalışmamızda, juvenil idiopatik artritli (JİA) çocuklarda hastalığın seyrinin ve kullanılan ilaçların metabolik sendrom (MetS) görülme sıklığı üzerine olan etkisini değerlendirmeyi amaçladık.Gereç ve Yöntemler: Çalışmamıza International League Against Rheumatism (ILAR) teşhis kriterlerine göre JİA tanısı almış, ek kronik hastalığı olmayan 10 ile 16 yaş arası 67 hasta alındı. Çalışmaya alınan olgularda MetS tanısı, Uluslararası Diyabet Federasyonu (IDF) tarafından yaş gruplarına göre belirlenen MetS tanı kriterlerine göre konuldu.Bulgular: Hastaların %38.8’i entesit ilişkili JİA, %38.8’i oligoartiküler JİA, %13.4’ü poliartiküler JİA, %8.9’u sistemik JİA olarak belirlendi. Hasta ailelerinin %54’ünde hipertansiyon (HT), %27’inde tip 2 diyabetes mellitus (T2DM), %39’unda obezite, %13’ünde inme, %36’sında ateroskleroz ve annelerin %4’ünde gestasyonel diabetes mellitus (GDM) öyküsü vardı. JİA’lı hastaların %4,47’sinde MetS varlığı belirlendi. Hastaların %9’unda vücut kitle indeksi (VKİ)>95p, %7’sinde HT, %6’sında trigliserid (TG)≥150 mg/dl, %24’ünde yüksek dansiteli lipoprotein (HDL)≤40 mg/dl, %7’sinde açlık kan şekeri (AKŞ) ≥100 mg/dl, %16’sında stria, %7’sinde akantozis nigrikans belirlendi. JİA’lı hastaların %16’sının non-steroid anti inflamatuvar ilaç (NSAİİ), %1’inin metotreksat (MTX), %10’unun salazosulfapyridine (SASP), %7’sinin glukokortikoid (GC)+SASP, %18’inin MTX+GC, %7’sinin MTX+SASP, %12’sinin MTX+SASP+GC, %1’inin anti-tümör nekrozis faktöralfa (Anti-TNF-α)+MTX+GC, %1’inin Anti-TNF-alfa+MTX+GC+SASP kullandığı belirlendi.Sonuç: Çalışmamızda, JİA’lı hastalarda hastalığın seyri ve kullanılan ilaçların MetS sıklığını arttırmadığı belirlendi. JİA’lı hastalarda tedavi seçeneklerinin iyi bilinmesi ve gerektiği durumlarda alternatif tedavilerin kullanılması halinde MetS ve komponentlerine bağlı komplikasyonların önemli ölçüde azalacağı belirlendi. Bu hastalarda, MetS üzerine yapılan çalışmaların artması hastalığın tanımlanması ve yönetimi açısından daha fazla bilgi sahibi olmamızı sağlayacaktır.

Anahtar Kelimeler

• Çocuk, İnsülin direnci, Juvenil idiyopatik artrit, Metabolik sendrom

Juvenile Idiopathic Arthritis Evaluation of the Metabolic Syndrome Incidence in Patients with

Öz

Objective: In our study we aimed to evaluate the effects of natural course of juvenile idiopathic arthritis (JIA) in children and drugs used for the treatment on the occurence frequency of metabolic syndrome.Material and Methods: Our study was conducted on 67 patients who were diagnosed according to the International League Against Rheumatism (ILAR) criteria between the ages of 10 and 16 without any accompanying chronic diseases. In the cases included in this study, metabolic syndrome (MetS) was diagnosed according to the criteria defi ned for the metabolic syndrome by International Diabetes Federation (IDF) based upon age groups.Results: 38.8% of patients were diagnosed with enthesitis-related JIA, 38.8% with oligoarticular, 13.4% with polyarticular and 8.9% with systemic JIA. In 54% of the patients’ parents, hypertension; in 27% type 2 diabetes mellitus (T2DM), in 39% obesity, in 13% stroke, in 36% atherosclerosis and fi nally in 4% of the mothers, gestational diabetes (GDM) were found to be present. MetS was found in 4.47% of the patients with JIA. In 9% of the patients BMI was >95p; in 7% hypertension was present; in 6% TG was ≥150 mg/dl; in 24% HDL-C was ≤40 mg/dl; in 7% Fasting Blood Glucose (FBG) was ≥100 mg/dl; in 16% there was strias, and fi nally in 7%, acanthosis nigricans were found. It was determined that 16% of the patients with JIA use NSAID; 1% use MTX; 10% use SASP; 7% use GC+SASP; 18% use MTX+GC; 7% use MTX+SASP; 12% use MTX+SASP+GC; 1% use Anti-TNF-α+MTX+GC; and %1 use Anti-TNFalfa+MTX+GC+SASP. Conclusion: In our study, it was determined that the continuation of the disease and the medicines used do not increase the density of MetS in the patients with JIA. It was determined that MetS and the complications dependent on its complications can decrease signifi cantly, provided that the alternatives of treatment are known well and these alternative treatments are used in patients with JIA, if necessary. In these patients, to increase the studies on MetS will help us be more informed about the identifi cation and management of the disease

Anahtar Kelimeler

• Child, Insulin resistance, Juvenile idiopathic arthritis, Metabolic syndrome

Kaynakça

1. Zanette Cde A, Machado SH, Brenol JC, Xavier RM. Metabolic syndrome and juvenile idiopathic arthritis. Rev Bras Reumatol ;50:190-204. Chen W, Berenson GS. Metabolic syndrome: Defi nition and prevalence in children. J Pediatr 2007;83:1-2.
2. Strufaldi MW, Silva EM, Puccini RF. Metabolic syndrome among prepubertal Brazilian schoolchildren. Diabetes Vasc Dis Res ;5:291-7. Bundak R, Furman A, Gunoz H, Darendeliler F, Bas F, Neyzi O. Body mass index references for Turkish children. Acta Paediatr ;95:194-8. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114:555-73.
3. Zimmet P, Alberti KGMM, Kaufman F, Tajima N, Silink M, Arslanian S, et al. IDF Consensus Group. The metabolic syndrome in children and adolescents-an IDF consensus report. Pediatric Diabetes ;8:299-306. rasyonları arasındaki ilişkiliyi göstermişlerdir. MetS’li hastaların Tablo IV: Metabolik sendrom tanısı alan olgular.   MetS tanısı alan olgular VKİ>95p+TG≥150mg/dl+AKŞ≥100mg/ (%1.49) dl+HT VKİ>95p+TG≥150mg/dl+HT (%1.49) VKİ>95p+TG≥150mg/dl+HDL≤40mg/ (%1.49) dl+HT