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Treatment of growth failure in juvenile chronic arthritis
Dominique Simon1, Nadine Lucidarme, Anne-Marie Prieur
1Service d'Endocrinologie et de Diabétologie Pediatriques, Hôpital Robert Debré, Paris, France. dominique.simon@rdb.ap-hop-paris.fr
Insights
Juvenile idiopathic arthritis (JIA) patients on steroid therapy experience significant height loss, with some achieving catch-up growth after treatment. Early growth hormone (GH) intervention may prevent long-term short stature in these children.
Area of Science:
- Pediatric Endocrinology
- Rheumatology
- Growth and Development
Background:
- Juvenile idiopathic arthritis (JIA) is associated with significant linear growth impairment.
- Steroid therapy, commonly used for JIA, can exacerbate growth deficits.
- Understanding growth patterns in JIA is crucial for developing effective treatment strategies.
Purpose of the Study:
- To assess linear growth and final height in JIA patients treated with steroids.
- To evaluate the impact of disease remission and steroid discontinuation on growth.
- To explore the potential of growth hormone (GH) therapy for improving final height in JIA.
Main Methods:
- Retrospective analysis of growth data from 24 JIA patients.
- Correlation of height loss with prednisone therapy duration.
- Assessment of catch-up growth and final height after steroid discontinuation.
- Evaluation of long-term GH treatment effects on growth velocity and height SDS.
Main Results:
- JIA patients experienced significant height loss correlated with prednisone duration.
- 70% of patients showed catch-up growth after remission, but 30% had persistent short stature.
- Final height was strongly correlated with height at steroid therapy completion.
- Long-term GH treatment increased growth velocity but had limited impact on final height SDS.
Conclusions:
- Steroid therapy in JIA significantly impacts linear growth, leading to potential short stature.
- Early intervention with GH may be necessary to prevent irreversible growth deterioration.
- Further research is needed to optimize GH treatment timing and dosage for JIA patients.
Abstract:
We retrospectively assessed linear growth and final height in a group of 24 patients suffering from juvenile idiopathic arthritis (JIA) during childhood, receiving steroid therapy. In these patients, a significant loss of height (-2.7 +/- 1.5 SDS) occurred in the first years of the disease which was positively correlated with prednisone therapy duration. After remission of the disease and prednisone discontinuation, most of the patients (70%) had catch-up growth but 30% had a persistent loss of height. Their mean final height was strongly correlated with their mean height at the end of steroid therapy and was significantly different between the group of patients with catch-up growth (-1.5 +/- 1.6 SDS) and the group without catch-up growth (-3.6 +/- 1.2 SDS). This pattern of growth observed in JIA patients should help us to define strategies of GH treatment in these patients in order to improve their final height. We have previously reported the beneficial effects on growth and body composition of a 1-year GH treatment in a group of 14 growth-retarded patients suffering from juvenile idiopathic arthritis, receiving glucocorticoid therapy. These patients (n = 13) were treated again with GH at the same dosage (0.46 mg/kg/week) for another 3-year period. GH treatment markedly increased growth velocity in these patients, but had a minor effect on SDS height suggesting that these children will remain short at adult age. Using GH earlier in these patients during the course of their disease may prevent growth deterioration and metabolic complications induced by chronic inflammation and long-term steroid therapy.