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Treatment of growth retardation in juvenile chronic arthritis with recombinant human growth hormone
U M Davies1, M Rooney, M A Preece
1MRC Clinical Research Centre, Northwick Park Hospital, Harrow, UK.
Objective:
To evaluate the effect of recombinant human growth hormone (rhGH) on the linear growth of children with persistently active juvenile chronic arthritis (JCA), most of whom were receiving steroid therapy. All of them were severely growth retarded, but had adequate GH secretion.
Methods:
After monitoring height velocity for one year, children were treated for the following year with either 12 IU/m2 or 24 IU/m2 of rhGH. During this period disease activity, drug treatment, dietary intake and bone maturation as well as linear growth were documented.
Results:
There was a significant increase in height velocity in almost all children during the treatment period. Children with mild to moderate disease activity grew at a better rate than those with very active disease. Children with polyarticular disease responded better than those with systemic JCA. Those children receiving high dose rhGH grew significantly more than those on the low dose regimen. Bone maturation did not exceed chronological age.
Conclusion:
We conclude the rhGH significantly increases the height velocity during one year of treatment. However, its effect on ultimate adult height remains unknown. Thus extensive longterm studies are required to evaluate the risk benefit ratio of this costly treatment.