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Linear growth and final height in patients with systemic juvenile idiopathic arthritis treated with longterm
Dominique Simon1, Catherine Fernando, Paul Czernichow
1Department of Endocrinology and Diabetology, Robert Debré Hospital, Paris, France.
Objective:
To assess linear growth and final height in patients given glucocorticoids during childhood for systemic juvenile idiopathic arthritis (JIA).
Methods:
Heights throughout followup for JIA and final height were recorded in 24 patients. Height data were expressed as the height standard deviation score for chronological age (HSDS/CA). Final height was compared to reference values for the French population and to target height.
Results:
During glucocorticoid therapy, mean loss of HSDS/CA was -2.7 +/- 1.5 and was positively correlated with prednisone therapy duration (p < 0.01). After prednisone discontinuation, 17 patients (70%) had catch-up growth and 7 (30%) continued to experience slow linear growth. Mean final height was -2.0 +/- 1.8 HSDS and was correlated with mean height at prednisone discontinuation (p < 0.0001). Mean final height was significantly greater in the patients with catch-up growth at prednisone discontinuation (-1.5 +/- 1.6 vs -3.6 +/- 1.2 HSDS), and 87% of patients had a final height below their target height.
Conclusion:
These data suggest that chronic inflammation and prednisone therapy may adversely affect growth in patients with JIA, and that final height may be closely dependent both on the severity of growth retardation during the active phase of the disease and on linear growth after remission. Thus treatments like growth hormone presently under investigation to improve final height may be most effective when given early after disease onset and/or at remission.