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Growth patterns in early juvenile idiopathic arthritis: Results from the Childhood Arthritis Prospective Study (CAPS)
Flora McErlane1, Roberto Carrasco2, Lianne Kearsley-Fleet2
1Paediatric Rheumatology, Great North Children's Hospital, Newcastle Hospitals NHS Trust, Newcastle upon Tyne, UK; Rheumatology, Institute Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
Insights
Children with juvenile idiopathic arthritis (JIA) show reduced height growth over three years. Early presentation is linked to better height outcomes, highlighting the need for timely paediatric rheumatology care.
Area of Science:
- Pediatric Rheumatology
- Growth and Development
- Child Health
Background:
- Juvenile idiopathic arthritis (JIA) can impact a child's growth trajectory.
- Understanding early vertical growth patterns is crucial for managing JIA.
- The Childhood Arthritis Prospective Study (CAPS) provides valuable data on pediatric arthritis.
Purpose of the Study:
- To investigate early vertical growth patterns in UK children with JIA.
- To identify factors associated with poor growth in this cohort.
- To analyze growth data from the CAPS inception cohort over a 3-year period.
Main Methods:
- Analysis of height z-scores and height velocity over 3 years.
- Utilized World Health Organisation growth standards for assessment.
- Employed univariable and multivariable linear regressions to identify growth predictors.
Main Results:
- A cohort of 568 children with JIA was analyzed.
- Significant decrease in height z-score observed from baseline to 3 years (p ≤ 0.0001).
- Growth restriction (change in height z-score ≤-0.5) affected 39% of patients; higher baseline height predicted poorer change.
Conclusions:
- Children with JIA experience reduced height growth in the first three years of the disease.
- Late presentation to pediatric rheumatology is associated with lower initial height.
- Patients with the lowest baseline height z-scores showed the most improvement at 3 years, emphasizing the importance of early intervention.
Objectives:
To investigate early vertical growth patterns and factors associated with poor growth in a modern inception cohort of UK children with juvenile idiopathic arthritis (JIA) using data from the Childhood Arthritis Prospective Study (CAPS).
Methods:
A study period of 3 years was chosen. Children included in this analysis had a physician diagnosis of JIA and had height measurements available at both baseline and at 3-years of follow-up. Height is presented as z-scores calculated using World Health Organisation growth standards for age and gender. Growth over the 3-year period was assessed using change in z-score and height velocity. Univariable and multivariable linear regressions were used to identify factors associated with height z-score at baseline and change of height z-score at 3 years.
Results:
568 patients were included; 65% female, median baseline age 7.4 years [interquartile range (IQR) 3.6, 11.2], median symptom duration at presentation 5.5 months [IQR 3.1, 11.6]. Height z-score decreased significantly from baseline to 3 years (p ≤ 0.0001); baseline median height z-score was -0.02 (IQR -0.71, 0.61), decreasing to -0.47 (IQR -1.12, 0.24) at 3 years. Growth restriction, defined as change of height z-score ≤-0.5, was observed in 39% of patients. At 3 years, higher baseline height z-score was the strongest predictor for a negative change in height z-score [-0.3 per unit of baseline height z-score (95% CI: -0.36, -0.24), p < 0.0001].
Conclusions:
Although overall height at 3 years after initial presentation to rheumatology is within the population norm, as a cohort, children with JIA experience a reduction of growth in height over the first 3 years of disease. Late presentation to paediatric rheumatology services is associated with lower height at presentation. However, patients with the lowest height z scores at presentation were also the most likely to see an improvement at 3 years. The impact of JIA on growth patterns is important to children and families and this study provides useful new data to support informed clinical care.
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