title: Effect of biologic treatments on growth in children with juvenile idiopathic arthritis.
abstract: OBJECTIVE
  Growth retardation is a frequent complication of severe juvenile idiopathic arthritis (JIA). Biologic treatments may improve growth velocity by controlling systemic inflammation and reducing corticosteroids. Our goals were to compare growth velocity before and after the onset of biologic therapy and to determine whether the JIA subtype, the use of steroids, the requirement of one or several biologic agents, or the disease activity influenced growth velocity.
  
  
  METHODS
  We retrospectively analyzed the growth of children with JIA who never received growth hormone treatment, who started biologic treatment before puberty, and who were followed for at least 6 months afterward.
  
  
  RESULTS
  We included 100 children (33 boys). Median patient age was 7.1 years (range: 1.6-15.7) at the onset of biologic treatment and 11.0 years (range: 2.3-19.5) at the latest followup. Forty-six patients had received corticosteroid and 34 had received more than 1 biologic agent. Patient median height expressed as SD score (SDS) was 0.31 (range: -2.47 to 5.46) at disease onset, -0.24 (-3.63 to 2.90) at biologic therapy onset (p < 0.0001), and -0.15 (-4.95 to 3.52) at the latest followup (p = 0.171 compared to biologic treatment onset). Patients who required several biologics and systemic patients had a significantly lower growth velocity after the onset of biologic treatment. At the latest followup, 18% of our study group had low growth velocities and 19% were below -2SD or shorter than genetically programmed.
  
  
  CONCLUSIONS
  In a subset of patients, particularly systemic JIA patients and patients who required more than 1 biologic, biologic therapy may be insufficient to restore normal growth velocity.
authors.affiliation: From the François Rabelais University, Clocheville Pediatric Hospital, Department of General Pediatrics; Pediatric Department, Centre Hospitalier Régional Universitaire (CHRU) Tours, Tours; Pediatric Immunology, Hematology and Rheumatology Unit, Pediatric Endocrinology, Biostatistics and Medical Informatics, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP); Université Paris Descartes, Paris, France; University Hospital Gasthuisberg, Pediatric Rheumatology, Leuven, Belgium.
authors.forename: Florence
authors.initials: F
authors.lastname: Uettwiller
authors.forename: Julie
authors.initials: J
authors.lastname: Perlbarg
authors.forename: Graziella
authors.initials: G
authors.lastname: Pinto
authors.forename: Brigitte
authors.initials: B
authors.lastname: Bader-Meunier
authors.forename: Richard
authors.initials: R
authors.lastname: Mouy
authors.forename: Sandrine
authors.initials: S
authors.lastname: Compeyrot-Lacassagne
authors.forename: Isabelle
authors.initials: I
authors.lastname: Melki
authors.forename: Carine
authors.initials: C
authors.lastname: Wouters
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Prieur
authors.forename: Paul
authors.initials: P
authors.lastname: Landais
authors.forename: Michel
authors.initials: M
authors.lastname: Polak
authors.forename: Pierre
authors.initials: P
authors.lastname: Quartier
mesh_terms: D000293:Adolescent; D018501:Antirheumatic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000188:drug therapy* / Q000503:physiopathology; D001688:Biological Products / Q000494:pharmacology* / Q000627:therapeutic use; D001827:Body Height / Q000187:drug effects* / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products
keywords: BIOLOGIC TREATMENT; CYTOKINE; GROWTH; JUVENILE ARTHRITIS; SYSTEMIC JUVENILE ARTHRITIS