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Ferritinemia as an indicator of systemic disease activity in children with systemic juvenile rheumatoid arthritis
Insights
Serum ferritin levels are extremely high in children with systemic juvenile rheumatoid arthritis during fever at diagnosis. Normalized ferritin levels during glucocorticoid treatment indicate fever response and guide dosage tapering.
Area of Science:
- Pediatric Rheumatology
- Clinical Biochemistry
Background:
- Systemic juvenile rheumatoid arthritis (SJRA) is a complex autoimmune disease in children.
- Elevated serum ferritin levels are observed in various inflammatory conditions.
Purpose of the Study:
- To investigate serum ferritin concentrations in children with SJRA.
- To assess the correlation of serum ferritin with disease activity and treatment response.
Main Methods:
- Longitudinal study of 20 children with SJRA (aged 0.9-13.7 years).
- Measurement of serum ferritin at diagnosis, during fever, and throughout 2-9 years of follow-up.
- Monitoring during glucocorticoid treatment.
Main Results:
- Extremely high serum ferritin levels (median 935 µg/l) were found at diagnosis during fever.
- Ferritin levels normalized rapidly (within weeks) during glucocorticoid treatment, correlating with fever response.
- Subnormal ferritin levels were observed later, independent of arthritis activity.
Conclusions:
- Serum ferritin is a sensitive indicator of acute inflammation in SJRA.
- Rapid normalization of serum ferritin reflects effective fever control with glucocorticoids.
- Serum ferritin can serve as a valuable guide for tapering glucocorticoid dosage.
Abstract:
Twenty children with systemic juvenile rheumatoid arthritis, aged 0.9-13.7 years, were studied with regard to their serum ferritin concentration at diagnosis and during follow-up, ranging from 2 to 9 years. At diagnosis, during fever, the concentration was extremely high. The median value was 935 micrograms/l. The values were unrelated to other manifestations of the disease or laboratory findings. During glucocorticoid treatment, the serum ferritin concentrations normalized rapidly, usually within a few weeks. The rate of normalization reflected the response of the fever to treatment. Later, subnormal concentrations were found, which were unrelated to the activity of the arthritis. Thus, serum ferritin is a useful guide when tapering glucocorticoid dosage.