title: Early recombinant human growth hormone treatment in glucocorticoid-treated children with juvenile idiopathic arthritis: a 3-year randomized study.
abstract: BACKGROUND
  Long-term glucocorticoid therapy adversely affects growth and body composition in children with juvenile idiopathic arthritis (JIA). In previous studies, recombinant human GH (rhGH) halted the progression of these complications without inducing catch-up growth.
  
  
  OBJECTIVE
  The objective of the study was to evaluate the impact on growth and body composition of rhGH started early after glucocorticoid initiation and to record adverse effects in children with JIA.
  
  
  METHODS
  This is a 3-yr randomized controlled study.
  
  
  METHODS
  This study was conducted in a teaching hospital.
  
  
  METHODS
  Thirty children, 12-15 months into glucocorticoid therapy for severe JIA, were enrolled.
  
  
  METHODS
  Patients received rhGH (0.46 mg/kg.wk) in daily sc injections (n = 15) or no rhGH therapy (n = 15) for 3 yr.
  
  
  METHODS
  Difference in height sd score (SDS) change between the two groups was assessed. Height velocity, body composition, and oral glucose tolerance were evaluated yearly.
  
  
  RESULTS
  Mean height SDS increase was larger with rhGH (+0.37 +/- 1.5 SDS) than without (-0.96 +/- 1.2 SDS) (P = 0.04). Mean height velocity returned to normal within the first year of rhGH treatment and remained normal thereafter. Mean lean mass increase was greater with rhGH treatment (+7.3 +/- 2.9 kg vs. +4.4 +/- 2.8 kg; P = 0.03). Fat mass and bone mineralization were not significantly different in the two groups. Fasting serum insulin increased significantly in rhGH-treated patients (5.2 +/- 16 mIU/liter) compared with untreated controls (-2.3 +/- 5 mIU/liter) (P = 0.04); fasting glycemia was unchanged.
  
  
  CONCLUSIONS
  rhGH started early in the course of JIA preserved normal growth velocity and height. Although rhGH was well tolerated, carbohydrate metabolism should be monitored closely.
authors.affiliation: Department of Pediatric Endocrinology, Robert Debré Teaching Hospital, 75019 Paris, France. dominique.simon@rdb.aphp.fr
authors.forename: Dominique
authors.initials: D
authors.lastname: Simon
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Prieur
authors.forename: Pierre
authors.initials: P
authors.lastname: Quartier
authors.forename: Jean
authors.initials: J
authors.lastname: Charles Ruiz
authors.forename: Paul
authors.initials: P
authors.lastname: Czernichow
mesh_terms: D001171:Arthritis, Juvenile / Q000188:drug therapy*; D001786:Blood Glucose / Q000187:drug effects; D001823:Body Composition / Q000187:drug effects; D002113:Calcification, Physiologic / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006130:Growth Disorders / Q000139:chemically induced* / Q000188:drug therapy*; D019382:Human Growth Hormone / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007223:Infant; D008297:Male; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D005938:Glucocorticoids; D019382:Human Growth Hormone