# Assessing the Association of Serum Zinc and Copper Levels With Disease Activity Using the Juvenile Arthritis Disease Activity Score (JADAS) in Juvenile Idiopathic Arthritis

## TL;DR

This study examines how serum zinc and copper levels relate to disease activity in juvenile idiopathic arthritis patients using the JADAS score.

## Contribution

The study provides new insights into the potential role of copper as a biomarker for disease activity in juvenile idiopathic arthritis.

## Key findings

- High disease activity in JIA patients was associated with significantly higher serum copper levels.
- Serum zinc levels were lower in active disease states but did not show statistically significant variation.
- Copper levels decreased significantly over time as disease activity improved.

## Abstract

Background

Alteration of zinc (Zn) and copper (Cu) levels could serve as a useful biomarker for assessing disease activity status in juvenile idiopathic arthritis (JIA) patients.

Objectives

To assess the serum zinc and copper levels and their association with disease activity status using the Juvenile Arthritis Disease Activity Score (JADAS) in JIA patients.

Methods

This was a prospective observational study. JIA patients who fulfilled the International League of Associations for Rheumatology (ILAR) classification criteria were enrolled in this study. Detailed history, clinical examination, and laboratory investigations were recorded. Serum zinc and copper levels were assessed at the initial visit, the 12th week, and the 24th week of follow-up. Disease activity status was assessed using the JADAS. Statistical analysis was used with appropriate tests (paired t-test, ANOVA) in SPSS 27.0 (IBM Corp., Armonk, NY).

Results

At enrollment, all JIA patients were in high disease activity, according to the JADAS score. Among them, seven (15.6%) and 23 (51.1%) of JIA patients showed inactive disease states at the 12th week and 24th week of follow-up. Serum zinc level was initially lower than normal and then gradually increased at 12 weeks and 24 weeks, respectively. However, these changes were not statistically significant. Conversely, mean serum copper levels were high at the initial visit, which significantly decreased by the 12th week (p < 0.05) and 24th week (p < 0.05). The analysis of serum zinc and copper levels revealed that while zinc showed no significant variation across disease activity states. JIA patients with high disease activity had notably higher mean serum copper levels (p < 0.05) compared to those with moderate, low, and inactive disease.

Conclusion

Serum zinc and copper levels vary with JIA disease activity. In active disease states, serum Cu levels were significantly increased, while serum Zn levels were decreased; however, the difference was not statistically significant.