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Impact of anti-TNF treatment on growth in severe juvenile idiopathic arthritis

P Tynjälä1, P Lahdenne, P Vähäsalo

  • 1Hospital for Children and Adolescents, Helsinki University Central Hospital, Research Unit, Lastenlinnantie 11 C 29, PL 280, 00029 HUS, Finland. pirjo.tynjala@hus.fi

Annals of the Rheumatic Diseases
|February 2, 2006
PubMed

Insights

Anti-tumour necrosis factor (TNF) treatment significantly improves growth velocity in children with severe juvenile idiopathic arthritis (JIA), especially those with prior growth delays. Pre-treatment growth rate is the strongest predictor of this improvement.

Area of Science:

  • Pediatric Rheumatology
  • Immunology
  • Endocrinology

Background:

  • Juvenile idiopathic arthritis (JIA) can cause significant growth disturbances in affected children.
  • Anti-tumour necrosis factor (anti-TNF) therapies are effective in managing JIA inflammation but their impact on growth requires further evaluation.
  • Identifying predictors of growth response can optimize treatment strategies for JIA patients.

Purpose of the Study:

  • To assess the effect of anti-TNF treatment on growth velocity in severe JIA.
  • To identify factors that predict changes in growth velocity during anti-TNF therapy.
  • To compare the efficacy of etanercept and infliximab on growth in JIA.

Main Methods:

  • Retrospective review of growth data from 71 JIA patients (polyarticular disease course) treated with etanercept or infliximab.
  • Analysis of growth velocity (change in height standard deviation score) two years before and two years after initiating anti-TNF therapy.
  • Statistical analysis to identify predictors of growth velocity changes, including pre-treatment growth rate and inflammatory activity.

Main Results:

  • Patients with pre-treatment growth delay experienced significant acceleration in growth velocity (+0.45 SD/year, p<0.001) during anti-TNF treatment.
  • Patients with normal or accelerated pre-treatment growth showed no significant change in growth velocity (+0.05 SD/year, p=0.39).
  • A decelerating growth rate prior to treatment was the strongest predictor of improved growth velocity; reduced inflammatory activity also remained a significant predictor.

Conclusions:

  • Anti-TNF therapy not only effectively suppresses inflammation in polyarticular JIA but also significantly restores impaired growth velocity.
  • The degree of growth restoration is strongly associated with the patient's growth trajectory before treatment initiation.
  • Anti-TNF agents represent a valuable therapeutic option for improving both inflammatory control and linear growth in children with JIA.
Abstract

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