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Endocrine dysfunction in patients with juvenile idiopathic arthritis
Sayan Mukherjee1, Abilash Krishnan Vijayakumaran1, Mukesh Kumar Maurya1
1Department of Clinical Immunology and Rheumatology, King George's Medical University, Lucknow, India.
Insights
Endocrine dysfunction affects one-third of children with Juvenile Idiopathic Arthritis (JIA), impacting growth and puberty. Altered growth hormone-insulin-like growth factor 1 (GH-IGF1) axis is a primary cause of these disturbances in JIA patients.
Area of Science:
- Pediatric Rheumatology
- Pediatric Endocrinology
- Growth and Development
Background:
- Juvenile Idiopathic Arthritis (JIA) is a chronic condition affecting children, with potential systemic implications.
- Endocrine dysfunction can significantly impact growth and sexual development in pediatric populations.
- Understanding these impacts is crucial for comprehensive JIA management.
Purpose of the Study:
- To determine the prevalence of endocrine dysfunction in children diagnosed with JIA.
- To identify factors contributing to impaired growth and sexual development in JIA patients.
- To investigate the role of the growth hormone-insulin-like growth factor 1 (GH-IGF1) axis.
Main Methods:
- A prospective observational study involving 107 children with JIA (disease duration > 6 months) was conducted.
- Evaluations included demographic, anthropometric, and hormonal assessments at baseline, with growth velocity recorded after one year.
- Statistical analysis employed Mann-Whitney U test, chi-square test, and Fisher's exact t test.
Main Results:
- 20.6% of JIA patients were stunted, 22.4% underweight, and 25.2% had low BMI, with correlations to disease onset, duration, damage, and activity.
- Children with low weight-for-age z-scores exhibited high growth hormone (GH) and low IGF Binding Protein 3 (IGFBP3) levels.
- Delayed puberty occurred in 2.8% of patients; girls with low estradiol levels showed prolonged corticosteroid exposure. 22.4% had unexplained slower growth velocity.
Conclusions:
- Approximately one-third of children with JIA experience growth and pubertal disturbances.
- The growth hormone-insulin-like growth factor 1 (GH-IGF1) axis is a primary factor in these developmental issues.
- Early identification and management of endocrine dysfunction are vital for JIA patients.
Objectives:
To assess the prevalence of endocrine dysfunction in patients with JIA and identify potential contributory factors for growth and sexual development.
Methods:
A prospective observational study was conducted between July 2021 to January 2023, recruited 107 children of JIA fulfilling the revised ILAR classification criteria with disease duration > 6 months, attending Rheumatology department in KGMU, India. Demographic, clinical (anthropometric), and serological (including hormonal) evaluations were assessed at baseline. Growth velocity was recorded after one year. Mann-Whitney U test, chi-square test, and Fisher's exact t test were applied during statistical analysis.
Results:
107 JIA patients were enrolled with a M: F ratio of 2.06:1 (72 boys & 35 girls) with ERA being the most frequent subtype (51.4%). Mean age was 13 (± 4) years with a disease duration of 33 (± 24) months. Mean glucocorticoid intake was 2.17 (± 5.41) mg/day at baseline. 20.6% children were stunted, 22.4% were underweight and 25.2% had low BMI. Stunted children were more likely to have early onset (p = 0.015) & high GH level (p = 0.013). Underweight children had longer disease (p = 0.047) and more damage (p = 0.006). Children with weight z < -2 have high GH and low IGFBP3. Low BMI group had high disease activity, damage, and poor quality of life & functional state (p = < 0.01). Delayed puberty was noticed only in 2.8% of children. Girls with low Estradiol level had longer exposure to corticosteroids. Slower growth velocity was observed in 22.4% of children without any identifiable cause.
Conclusion:
One third of JIA patients experience growth and pubertal disturbances, primarily due to altered GH-IGF1 axis.
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