Juvenile Idiopathic Arthritis and Secondary Cardiometabolic Risk in Paediatric Populations

Abstract

Juvenile idiopathic arthritis is the most common chronic inflammatory rheumatic disease of childhood. It is traditionally considered a joint-limited disorder. Recent evidence shows that juvenile idiopathic arthritis is a systemic inflammatory condition. Persistent inflammation affects metabolic and cardiovascular health from an early age. Children with juvenile idiopathic arthritis are at increased risk of developing secondary cardiometabolic abnormalities. Chronic inflammation in mjuvenile idiopathic arthritis is associated with elevated levels of pro-inflammatory cytokines. These cytokines disrupt insulin signalling and lipid metabolism. Altered adipokine secretion contributes to insulin resistance and dyslipidaemia. Endothelial dysfunction and early vascular changes such as increased carotid intima-media thickness have been reported in affected children. Oxidative stress further worsens metabolic imbalance and vascular injury. Antirheumatic therapies influence cardiometabolic risk in different ways. Effective disease control using conventional disease-modifying antirheumatic drugs and biologic agents can reduce inflammation-driven metabolic complications. In contrast prolonged glucocorticoid exposure is associated with weight gain hypertension impaired glucose tolerance and adverse lipid profiles. These effects are particularly concerning in paediatric populations due to long treatment duration. Reduced physical activity is common in children with juvenile idiopathic arthritis due to pain stiffness and fatigue. This leads to unfavourable body composition with increased fat mass and reduced muscle mass. Lifestyle factors including poor diet limited exercise and psychosocial stress further increase cardiometabolic risk. This review summarises the pathophysiological mechanisms linking juvenile idiopathic arthritis with secondary cardiometabolic risk. It also highlights the impact of treatment and lifestyle factors. Early screening optimal inflammation control and multidisciplinary preventive strategies are essential to improve long-term cardiovascular and metabolic outcomes in children with juvenile idiopathic arthritis.