title: Treatment of growth failure in juvenile chronic arthritis.
abstract: We retrospectively assessed linear growth and final height in a group of 24 patients suffering from juvenile idiopathic arthritis (JIA) during childhood, receiving steroid therapy. In these patients, a significant loss of height (-2.7 +/- 1.5 SDS) occurred in the first years of the disease which was positively correlated with prednisone therapy duration. After remission of the disease and prednisone discontinuation, most of the patients (70%) had catch-up growth but 30% had a persistent loss of height. Their mean final height was strongly correlated with their mean height at the end of steroid therapy and was significantly different between the group of patients with catch-up growth (-1.5 +/- 1.6 SDS) and the group without catch-up growth (-3.6 +/- 1.2 SDS). This pattern of growth observed in JIA patients should help us to define strategies of GH treatment in these patients in order to improve their final height. We have previously reported the beneficial effects on growth and body composition of a 1-year GH treatment in a group of 14 growth-retarded patients suffering from juvenile idiopathic arthritis, receiving glucocorticoid therapy. These patients (n = 13) were treated again with GH at the same dosage (0.46 mg/kg/week) for another 3-year period. GH treatment markedly increased growth velocity in these patients, but had a minor effect on SDS height suggesting that these children will remain short at adult age. Using GH earlier in these patients during the course of their disease may prevent growth deterioration and metabolic complications induced by chronic inflammation and long-term steroid therapy.
authors.affiliation: Service d'Endocrinologie et de Diabétologie Pediatriques, Hôpital Robert Debré, Paris, France. dominique.simon@rdb.ap-hop-paris.fr
authors.forename: Dominique
authors.initials: D
authors.lastname: Simon
authors.forename: Nadine
authors.initials: N
authors.lastname: Lucidarme
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Prieur
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Ruiz
authors.forename: Paul
authors.initials: P
authors.lastname: Czernichow
mesh_terms: D001171:Arthritis, Juvenile / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D001823:Body Composition; D001827:Body Height; D002675:Child, Preschool; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects; D006130:Growth Disorders / Q000188:drug therapy* / Q000209:etiology*; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D011241:Prednisone / Q000009:adverse effects
chemical_list: D005938:Glucocorticoids; D019382:Human Growth Hormone; D011241:Prednisone