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Natural history of growth and body composition in juvenile idiopathic arthritis
1Division of Pediatric Endocrinology, University Children's Hospital, Munich, Germany. susanne.bechtold@med.uni-muenchen.de
Insights
Juvenile idiopathic arthritis (JIA) often leads to growth impairment and altered body composition, impacting final height. Early identification and management of these complications are crucial for improving long-term outcomes in children with JIA.
Area of Science:
- Pediatric Rheumatology
- Endocrinology
- Orthopedics
Background:
- Juvenile idiopathic arthritis (JIA) is associated with significant long-term complications, including impaired growth and abnormal body composition.
- Growth deficits are observed during active disease phases and often persist despite treatment, leading to final heights below genetic potential.
- Bone mass deficits are common in JIA patients, regardless of glucocorticoid (GC) treatment, and are increasingly linked to muscle mass deficits.
Purpose of the Study:
- To highlight the prevalence and impact of growth impairment and altered body composition in juvenile idiopathic arthritis.
- To emphasize the need for early recognition and management of these complications in JIA patients.
- To underscore the importance of addressing growth disturbances and body composition for long-term patient well-being.
Main Methods:
- Longitudinal growth data analysis in systemic and polyarticular JIA.
- Assessment of body composition, including bone and muscle mass.
- Review of existing literature on growth and body composition in JIA.
Main Results:
- Growth impairment is evident during active JIA phases, with limited 'catch-up' growth in many patients.
- Final height is frequently below the 3rd percentile and genetic potential.
- Significant deficits in bone and muscle mass are prevalent in children with JIA.
Conclusions:
- Optimal disease control in JIA should prioritize maintaining normal growth and body composition.
- Early identification of growth disturbances and altered body composition is essential for mitigating long-term morbidity.
- Diagnostic and therapeutic strategies must address these abnormalities in the comprehensive care of children with JIA.
Background:
In patients with juvenile idiopathic arthritis (JIA), growth impairment and altered body composition, including disturbed skeletal development, are well-known long-term complications. Data on longitudinal growth in patients with systemic and polyarticular JIA reveal growth impairment in the active phases of the disease. With reduction in disease activity and lower glucocorticoid (GC) doses, some patients experience 'catch-up' growth; however, many have only a slight improvement in height standard deviation during puberty or after cessation of GC treatment. The consequence is a final height below the 3rd percentile and below the genetic height potential. Although few studies have specifically addressed body composition in children with JIA, studies on the development of bone mass have described notable deficits in both GC-treated and GC-naïve children. In recent years, the deficits in bone mass have been related, in part, to the deficits in muscle mass, which are prevalent in these patients.
Conclusions:
The major goal for physicians caring for patients with JIA is optimal disease control while maintaining normal growth. Early recognition of patients who develop prolonged growth disturbances and altered body composition is important as these abnormalities contribute to long-term morbidity and need to be addressed both diagnostically and therapeutically when treating children with JIA.
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