Promoting growth in chronic inflammatory disease: lessons from studies of the growth plate.
BACKGROUND
Growth disorders are commonly observed in children with chronic inflammatory disease. It is likely that these disorders are mediated by a combination of factors, including the disease process and its treatment (with drugs such as glucocorticoids [GCs]). These factors affect the growth hormone-insulin-like growth factor I (IGF-I) axis, which is crucial for promoting linear growth at the level of the growth plate. Recent advances in our knowledge of the effects of GCs and proinflammatory cytokines on the growth plate have led to an improved understanding of the biological rationale for the use of growth-promoting therapy in children with chronic inflammatory disease and concurrent growth retardation.


CONCLUSIONS
Both GCs and proinflammatory cytokines can adversely affect a number of components of growth plate chondrogenesis, and these effects can be ameliorated by raising local IGF-I exposure. However, this intervention does not lead to complete normalization of the growth plate. In children with chronic inflammation, the cornerstone of improving growth remains the judicious use of GCs while ensuring effective control of the disease process.
Ahmed
S F
SF
Bone and Endocrine Research Group, Division of Developmental Medicine, University of Glasgow, Royal Hospital for Sick Children, Glasgow, UK.
Sävendahl
L
L
D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002478:Cells, Cultured; D002648:Child; D020219:Chondrogenesis; D005938:Glucocorticoids; D006128:Growth; D006130:Growth Disorders / Q000188:drug therapy; D013006:Growth Hormone / Q000627:therapeutic use; D006132:Growth Plate / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D007249:Inflammation / Q000503:physiopathology*; D007334:Insulin-Like Growth Factor I / Q000627:therapeutic use; D053583:Interleukin-1beta / Q000009:adverse effects; D014409:Tumor Necrosis Factor-alpha / Q000009:adverse effects
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D053583:Interleukin-1beta; D014409:Tumor Necrosis Factor-alpha; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone