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Influence of biologic therapy on growth in children with chronic inflammatory connective tissue diseases
Joanna Świdrowska1, Agnieszka Zygmunt1, Małgorzata Biernacka-Zielińska1
1Department of Pediatric Cardiology and Rheumatology, Medical University of Lodz, Poland.
Insights
Biological therapies significantly improve growth velocity in children with chronic inflammatory connective tissue diseases (CTD). This is achieved by reducing inflammation and lowering glucocorticosteroid (GCS) doses, leading to normalized growth rates.
Area of Science:
- Pediatric Rheumatology
- Growth and Development
- Immunology
Background:
- Connective tissue diseases (CTD) in children can cause growth inhibition due to inflammation and glucocorticosteroid (GCS) therapy.
- Juvenile spondyloarthropathies and juvenile idiopathic arthritis (JIA) are particularly associated with impaired growth velocity.
- Disease activity and GCS dosage significantly impact abnormal growth patterns in pediatric CTD patients.
Purpose of the Study:
- To evaluate the impact of biological therapy on growth velocity in children with chronic inflammatory CTD.
- To assess the relationship between biological treatment, inflammation control, and GCS reduction on pediatric growth.
- To analyze growth rate changes in relation to GCS doses and biological agent type/duration.
Main Methods:
- Retrospective review of 24 pediatric CTD patients treated with TNF-α blockers or IL-6 receptor blockers.
- Growth rate assessment at disease onset, biologic initiation, and 12-24 months post-initiation.
- Correlation analysis of growth rate with GCS doses and biological therapy characteristics.
Main Results:
- Growth velocity accelerated in 70.1% of patients during biological treatment.
- Mean height-SDS improved by 0.51 ±0.58 between biologic initiation and two years.
- 47% of patients achieved a GCS dose reduction to 0 mg/kg/day.
Conclusions:
- Biological agents effectively restore growth velocity in pediatric CTD patients.
- Therapeutic benefits include both direct inflammation inhibition and reduced GCS dependence.
- Biological therapy offers a dual mechanism for normalizing growth in children with CTD.
Objectives:
Connective tissue diseases (CTD) are a heterogeneous group of chronic inflammatory conditions. One of their complications in children is the inhibition of growth velocity. Due to direct inflammation within the musculoskeletal system as well as glucocorticoid therapy, this feature is the most essential and is mainly expressed in the course of juvenile spondyloarthropathies and juvenile idiopathic arthritis (JIA). Duration of the disease, but predominantly the activity of the inflammatory process, seems to have a significant impact on the abnormal growth profile in children. Effective biological therapy leads to improvement of the patient's clinical condition and also, through the extinction of disease activity and reduction of daily doses of glucocorticosteroids (GCS), it gradually accelerates and normalizes the growth rate in children with CTD. Our objective was to evaluate the impact of biological therapy on growth in children with chronic inflammatory CTD.
Material And Methods:
Data from 24 patients with CTD treated with tumor necrosis factor-α-blockers (etanercept, adalimumab, golimumab) and an interleukin-6 receptor blocker (tocilizumab) were reviewed at the time of disease onset, biological treatment initiation and at least 12 up to 24 months onwards. The rate of growth was correlated with the daily doses of GCS, and the type and duration of biological therapy.
Results:
Patient median height, measured as the change in height standard deviation score, was 0.36 ±1.07 at disease onset and -0.13 ±1.02 at biologic therapy initiation. The growth velocity accelerated in 17 patients (70.1%) during the biological treatment. Mean height-SDS improvement between biological treatment initiation up to two years was 0.51 ±0.58. In 47% of patients daily doses of GCS were reduced to 0 mg/kg/day.
Conclusions:
In the treatment of CTD, biological agents restore growth velocity not only by inflammation inhibition, but also through limiting GCS daily doses.
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