Early recombinant human growth hormone treatment in glucocorticoid-treated children with juvenile idiopathic arthritis: a 3-year randomized study.
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.
Simon
Dominique
D
Department of Pediatric Endocrinology, Robert Debré Teaching Hospital, 75019 Paris, France. dominique.simon@rdb.aphp.fr
Prieur
Anne-Marie
AM
Quartier
Pierre
P
Charles Ruiz
Jean
J
Czernichow
Paul
P
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
D001786:Blood Glucose; D005938:Glucocorticoids; D019382:Human Growth Hormone