Elsevier

Thrombosis Research

Volume 92, Issue 6, 15 December 1998, Pages 267-272
Thrombosis Research

REGULAR ARTICLE
Activation of the Haemostatic System in Children with Juvenile Rheumatoid Arthritis Correlates with Disease Activity

https://doi.org/10.1016/S0049-3848(98)00145-5Get rights and content

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.

Section snippets

Patients and Methods

The study comprised 24 children aged from 5 to 17 years with different clinical subtypes of juvenile rheumatoid arthritis according to the classification criteria of the American College of Rheumatology (ACR) [10], (systemic onset arthritis: 4, seronegative chronic polyarthritis: 7, pauciarticular arthritis type I: 4; pauciarticular arthritis type II: 9) and 10 patients with postinfectious arthropathies. Postinfectious arthropathies were defined as nonseptic oligo- or monoarticular affections

Results

F1+2, TAT, D-Dimer, and fibrinogen were significantly elevated in patients with JRA as compared with healthy controls (p<0.001) and patients with postinfectious arthropathies (F1+2: p=0.014, TAT: p=0.01, D-Dimer: p=0.003, fibrinogen: p=0.026). Patients with postinfectious arthropathies showed significantly higher concentrations of F1+2 (p=0.018) and D-Dimer (p=0.008) as compared with controls (Table 1).

Table 2 shows significant correlation between the joint index score, CRP, haemoglobin and F1+2

Discussion

In the present study in JRA patients, a significant elevation of very sensitive haemostatic molecular markers such as F1+2, TAT, and D-Dimer indicates a pronounced activation of the haemostatic system. The elevated haemostatic activation markers correlated significantly with JRA disease activity scores and conventional inflammatory parameters like CRP and haemoglobin.

Alterations of the haemostatic system may contribute to the destructive and fibroproliferative processes in chronic inflammatory

References (25)

  • L.R. Zacharski et al.

    Pathways of coagulation activation in situ in rheumatoid synovial tissue

    Clin Immunol Immunopathol

    (1992)
  • M.P. McGee et al.

    Functional difference between intrinsic and extrinsic coagulation pathways. Kinetics of factor X activation on human monocytes and alveolar macrophages

    J Biol Chem

    (1991)
  • I. Clemmensen et al.

    Fibrin and fibronectin in rheumatoid synovial membrane and rheumatoid synovial fluid

    Arthritis Rheum

    (1983)
  • L.E. Glynn

    The chronicity of inflammation and its significance in rheumatoid arthritis

    Ann Rheum Dis

    (1968)
  • J.A. Hamilton et al.

    Regulation of plasminogen activator activity in arthritic joints

    J Rheumatol

    (1991)
  • E.C. Gabazza et al.

    Correlation between clotting and collagen metabolism markers in rheumatoid arthritis

    Thromb Haemost

    (1994)
  • J.P. Scott et al.

    Evidence for intravascular coagulation in systemic onset, but not polyarticular, juvenile rheumatoid arthritis

    Arthritis Rheum

    (1985)
  • F. De Benedetti et al.

    Solubel tumour necrosis factor receptor levels reflect coagulation abnormalities in sytemic juvenile chronic arthritis

    Br J Rheumatol

    (1997)
  • Y. Inamo et al.

    Increase of activated factor VIIa and haemostatic molecular markers in juvenile chronic arthritis

    Br J Rheumatol

    (1995)
  • H. Mangge et al.

    Serum cytokines in juvenile rheumatoid arthritis. Correlation with conventional inflammatory parameters and clinical subtypes

    Arthritis Rheum

    (1995)
  • J.G. Schaller

    Juvenile rheumatoid arthritis

    Pediatrics in Review

    (1980)
  • M.L.L. Prevoo et al.

    Validity and reliability of joint indicesA longitudinal study in patients with recent onset rheumatoid arthritis

    Br J Rheumatol

    (1993)
  • Cited by (22)

    View all citing articles on Scopus
    View full text