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Growth patterns in juvenile rheumatoid arthritis
1Section of Rheumatology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada.
Insights
Juvenile rheumatoid arthritis (JRA) can cause growth delays, particularly in systemic and RF-positive polyarticular forms. Pauciarticular and RF-negative polyarticular JRA patients often exhibit normal growth patterns.
Area of Science:
- Pediatric Rheumatology
- Growth and Development
- Child Health
Background:
- Juvenile rheumatoid arthritis (JRA) is a chronic inflammatory condition affecting children.
- Growth disturbances are a significant concern in children with JRA.
- Understanding growth patterns is crucial for managing JRA and its long-term effects.
Purpose of the Study:
- To define growth patterns in children with JRA.
- To identify clinical and laboratory factors associated with growth deviations in JRA.
- To compare growth trajectories across different JRA subtypes.
Main Methods:
- Longitudinal study of 67 children with JRA followed for at least 5 years.
- Calculation of height and weight z-scores annually.
- Correlation of growth z-scores with JRA subtype, rheumatoid factor (RF) status, ESR, ALP, and medication history.
Main Results:
- Systemic JRA (SJRA) onset group showed significantly lower height-for-age z-scores (HAZ) compared to pauciarticular JRA (PaJRA) from year 2 and polyarticular JRA (PoJRA) from year 6.
- RF-positive children tended to have negative HAZ scores, while RF-negative children tended to have positive HAZ scores.
- Predominant linear growth delay observed in SJRA, with lesser impact in RF-positive PoJRA.
Conclusions:
- Linear growth delay is a recognized complication in some JRA patients.
- Pauciarticular and RF-negative PoJRA patients may exhibit normal growth.
- RF-positive PoJRA and SJRA patients experience more significant growth retardation, which can be sustained and extreme.
Objective:
To define patterns of growth in juvenile rheumatoid arthritis (JRA) and to evaluate possible associated clinical and laboratory correlates.
Methods:
The study population comprised 67 children with JRA who had been followed for 5 years or longer and whose follow-up period did not extend beyond 18 years of age. Height and weight z scores were calculated with reference to age-related standards for each of the annual follow-up intervals and correlated with JRA subtype, the presence of rheumatoid factor (RF), the erythrocyte sedimentation rate (ESR), alkaline phosphatase level (ALP) and medication history.
Results:
Initial height-for-age (HAZ) scores for pauciarticular, polyarticular and systemic JRA onset groups (PaJRA, PoJRA and SJRA respectively) were +0.27, -0.07 and +0.40 respectively. A significantly lower HAZ score in the SJRA population compared to the PaJIA population first became apparent at year 2 and the difference was maintained throughout the 9-year follow-up period. A significantly lower HAZ score in the SJRA population compared to the PoJRA population first became apparent at year 6 and the difference was maintained until the ninth year. During the 9-year follow-up period, RF-positive children tended to have negative HAZ scores whereas RF-negative children tended to have positive HAZ scores. The SJRA onset group displayed significantly lower HAZ scores, as compared to the HAZ score at onset, for 7 of the 9 subsequent follow-up intervals. Only 2 patients had heights < 2SD below the mean at final determination. Delay in generalized linear growth occurred predominantly in the SJRA population and to a lesser degree in those with PoJRA associated with RF positivity.
Conclusions:
Delay in linear growth occurs in some children with JRA. Patients with pauciarticular and RF-negative polyarticular disease can have growth patterns similar to normal children. Children with RF-positive polyarticular and systemic JRA have more significant growth retardation that occasionally can be sustained and extreme.
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