Kahraman YAKUT, Müferet ERGÜVEN, Nurhayat YAKUT

Juvenil İdiopatik Artritli Hastalarda Metabolik Sendrom Değerlendirilmesi

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 tanısıalmış, ek kronik hastalığı olmayan 10 ile 16 yaş arası 67 hasta alındı. Çalışmaya alınan olgularda MetS tanısı, UluslararasıDiyabet Federasyonu (IDF) tarafından yaş gruplarına göre belirlenen MetS tanı kriterlerine göre konuldu.Bulgular: Hastaların %38.8i entesit ilişkili JİA, %38.8i oligoartiküler JİA, %13.4ü poliartiküler JİA, %8.9u sistemik JİAolarak belirlendi. Hasta ailelerinin %54ünde hipertansiyon (HT), %27inde tip 2 diyabetes mellitus (T2DM), %39undaobezite, %13ünde inme, %36sında ateroskleroz ve annelerin %4ünde gestasyonel diabetes mellitus (GDM) öyküsüvardı. JİAlı hastaların %4,47sinde MetS varlığı belirlendi. Hastaların %9unda vücut kitle indeksi (VKİ)>95p, %7sindeHT, %6sında trigliserid (TG)≥150 mg/dl, %24ünde yüksek dansiteli lipoprotein (HDL)≤40 mg/dl, %7sinde açlık kanşekeri (AKŞ) ≥100 mg/dl, %16sında stria, %7sinde akantozis nigrikans belirlendi. JİAlı hastaların %16sının non-steroidanti inﬂ amatuvar ilaç (NSAİİ), %1inin metotreksat (MTX), %10unun salazosulfapyridine (SASP), %7sinin glukokortikoid(GC)+SASP, %18inin MTX+GC, %7sinin MTX+SASP, %12sinin MTX+SASP+GC, %1inin anti-tümör nekrozis faktör- alfa (Anti-TNF-α)+MTX+GC, %1inin Anti-TNF-alfa+MTX+GC+SASP kullandığı belirlendi. Sonuç: Çalışmamızda, JİAlı hastalarda hastalığın seyri ve kullanılan ilaçların MetS sıklığını arttırmadığı belirlendi. JİAlıhastalarda tedavi seçeneklerinin iyi bilinmesi ve gerektiği durumlarda alternatif tedavilerin kullanılması halinde MetS vekomponentlerine bağlı komplikasyonların önemli ölçüde azalacağı belirlendi. Bu hastalarda, MetS üzerine yapılan çalış- maların artması hastalığın tanımlanması ve yönetimi açısından daha fazla bilgi sahibi olmamızı sağlayacaktır.

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

Objective: In our study we aimed to evaluate the effects of natural course of juvenile idiopathic arthritis (JIA) in childrenand 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 InternationalLeague 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 themetabolic 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% withpolyarticular 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% FastingBlood Glucose (FBG) was ≥100 mg/dl; in 16% there was strias, and ﬁ nally in 7%, acanthosis nigricans were found. Itwas 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-TNF- alfa+MTX+GC+SASP.Conclusion: In our study, it was determined that the continuation of the disease and the medicines used do not increasethe density of MetS in the patients with JIA. It was determined that MetS and the complications dependent on itscomplications can decrease signiﬁ cantly, provided that the alternatives of treatment are known well and these alternativetreatments are used in patients with JIA, if necessary. In these patients, to increase the studies on MetS will help us bemore informed about the identiﬁ cation and management of the disease.

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