Growth retardation and osteoporosis in juvenile chronic arthritis

Disturbance of growth and bone metabolism is a serious problem in juvenile chronic arthritis. The major factors appear to be chronic disease activity and steroid therapy. Retardation of linear growth is due to disturbance of the neuroendocrine axis, where there is no obvious growth hormone deficiency, but marked reduction of the serum concentration of its mediator, insulin growth factor 1 (IGF-1). Its reduced serum concentration may be multifactorial. In addition, there is also evidence of target insensitivity to IGF-1. The role of the inflammatory cytokines in these endocrine disturbances is likely to be very important, and is the subject of current research.