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GH therapy in juvenile chronic arthritis: results of a two-year controlled study on growth and bone
S Bechtold1, P Ripperger, D Mühlbayer
1Endocrine Division University Children's Hospital, D-80337 Munich, Germany. susanne.bechtold@kk-i.med.uni-muenchen.de
Insights
Human growth hormone (hGH) treatment improved growth velocity and height in prepubertal children with juvenile chronic arthritis (JCA). GH therapy may counteract glucocorticoid side effects, but long-term studies are needed.
Area of Science:
- Pediatric Endocrinology
- Rheumatology
- Growth Hormone Therapy
Background:
- Juvenile chronic arthritis (JCA) frequently causes growth disturbances in children.
- Reduced final height is a permanent consequence of growth impairment in JCA.
- Glucocorticoid therapy, often used for JCA, can also impede growth.
Purpose of the Study:
- To evaluate the efficacy and safety of human growth hormone (hGH) in growth-retarded prepubertal children with JCA.
- To assess the impact of hGH on growth velocity and height parameters.
- To investigate the potential of hGH to mitigate adverse effects of glucocorticoids.
Main Methods:
- Thirty-five prepubertal children with JCA were assessed for GH deficiency (GHD).
- Children were randomized into a study group (hGH treatment) and an untreated control group.
- The study group received 1 IU/kg BW/wk of hGH, and the GHD group received 0.5 IU for 2 years.
Main Results:
- hGH treatment led to significant increases in growth velocity and height standard deviation (SD) scores compared to baseline.
- Both treated groups showed marked growth velocity increases, with some increase also observed in the control group.
- Insulin-like growth factor-I (IGF-I) and IGF-binding protein-3 levels increased with GH treatment.
Conclusions:
- hGH therapy shows potential utility in treating growth impairment associated with JCA.
- GH may counteract growth-inhibiting effects of glucocorticoids in JCA patients.
- Further long-term controlled studies are necessary to establish definitive risks and benefits of GH therapy in JCA.
Abstract:
Disturbance of growth frequently occurs in children suffering from juvenile chronic arthritis (JCA). Recognition of growth impairment is important because reduced final height is one of the permanent consequences. The aim of this study was to evaluate the efficacy and safety of human GH (hGH) in growth-retarded prepubertal children with JCA. Thirty-five children were tested for GH deficiency (GHD) and randomly assigned to a study and an untreated control group; five were GH deficient and were part of the GHD group. All received glucocorticoids. The study group was treated with 1 IU/kg BW.wk hGH; the GHD group was given 0.5 IU. During 2 yr of hGH treatment growth velocity and height SD score increased compared with baseline values. There was a marked increase in growth velocity in the treated groups, but also some increase in the control group. Plasma levels of IGF-I and IGF-binding protein-3 increased with GH treatment. These results suggest that hGH might be useful in the treatment of growth impairment in JCA. GH may counteract the adverse effects of glucocorticoid therapy, but its effect is dependent on the disease activity. Long-term controlled studies are needed to determine the risks and benefits of GH therapy in JCA.