Effects on growth and body composition of growth hormone treatment in children with juvenile idiopathic arthritis requiring steroid therapy.
OBJECTIVE
Decreased growth velocity and abnormal body composition including severe osteoporosis are common in glucocorticoid-treated patients with juvenile idiopathic arthritis (JIA). We evaluated the effects of recombinant human growth hormone (GH) given for 3 years on growth velocity, height standard deviation score (SDS), and body composition, together with potential adverse effects on glucose tolerance.


METHODS
Thirteen patients received GH (0.46 mg/kg/week) for 3 years. Body composition was assessed by dual-energy x-ray absorptiometry and glucose tolerance by annual oral glucose tolerance tests.


RESULTS
Median growth velocity increased from 2.1 to 6.0 cm/year (p = 0.002) in the first year and remained higher than baseline in the second year of treatment. Height SDS did not change significantly (-4.6 SDS at baseline vs -4.3 SDS at study completion), but the growth response varied markedly across patients. Compared with baseline, lean mass increased by 33%, fat mass remained stable, and lumbar bone mineral density increased by 36.6%. Transient glucose intolerance developed in 6 patients, but glycosylated hemoglobin concentrations did not change significantly and diabetes mellitus did not occur.


CONCLUSIONS
Treatment with GH restored linear growth without inducing catch-up growth, significantly improved body composition, and prevented further bone loss. Prolonged followup is needed to assess the benefits of GH and longterm consequences of hyperinsulinism.
Simon
Dominique
D
Department of Endocrinology and Diabetology, Robert Debré Teaching Hospital, 48 Boulevard Sérurier, 75019 Paris, France. dominique.simon@rdb.ap-hop-paris.fr
Lucidarme
Nadine
N
Prieur
Anne-Marie
AM
Ruiz
Jean Charles
JC
Czernichow
Paul
P
D000293:Adolescent; D001171:Arthritis, Juvenile / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology*; D001823:Body Composition / Q000187:drug effects; D001827:Body Height / Q000187:drug effects; D015519:Bone Density / Q000187:drug effects; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D018149:Glucose Intolerance / Q000209:etiology; D006442:Glycated Hemoglobin / Q000032:analysis; D006128:Growth / Q000187:drug effects; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D008159:Lumbar Vertebrae / Q000378:metabolism; D008297:Male; D013256:Steroids / Q000627:therapeutic use*; D013997:Time Factors
D006442:Glycated Hemoglobin; D019382:Human Growth Hormone; D013256:Steroids