Bone metabolism in juvenile rheumatoid arthritis

Bianchi, M.L.; Bardare, M; Caraceni, M.P.; Cohen, Ezra; Falvella, S.; Borzani, M; DeGaspari, M.G.

doi:10.1016/0169-6009(90)90081-p

Cited by 43 publications

(35 citation statements)

References 18 publications

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“…In accordance with our previously published data [28,29] and other reports [30], corticosteroids showed a negative action on bone mass, and in particular on the predominantly trabecular sites, such as spine. In fact, lower increases in spinal bone mass were found in patients with higher cumulative doses of corticosteroids.…”

Section: Discussionsupporting

confidence: 92%

Bone Mass Change During Methotrexate Treatment in Patients with Juvenile Rheumatoid Arthritis

Bianchi

Cimaz

Galbiati

et al. 1999

Osteoporosis International

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Thirty-two children affected by juvenile rheumatoid arthritis (JRA) were studied with serial measurements of bone mass for an average of 18 months, to evaluate the effects of long-term methotrexate (MTX) treatment on bone. Bone mineral density (BMD) was measured on lumbar spine and total body. During MTX therapy some increase in BMD was observed, though this was smaller than in a control group of healthy children. Axial (spine and trunk) and appendicular (upper and lower limbs) BMD showed similar increases. BMD, either as an absolute value or as a percent variation from baseline, did not correlate with either MTX dose or length of therapy. In children treated also with corticosteroids, these drugs negatively influenced bone mass increase. The main determinant of absolute spine BMD value appeared to be weight, while height and lean mass seemed to be the determinants of total body BMD. Pubertal stage and disease activity significantly influenced the yearly change in BMD. In conclusion, our data suggest that long-term, low-dose therapy with MTX does not induce osteopenia in children with JRA.

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Section: Discussionsupporting

confidence: 92%

Bone Mass Change During Methotrexate Treatment in Patients with Juvenile Rheumatoid Arthritis

Bianchi

Cimaz

Galbiati

et al. 1999

Osteoporosis International

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“…This excluded many patients with more severe JRA, and the subjects in this study had mild-tomoderate JRA severity. This may explain why this study disagrees with those of other investigators who demonstrated significantly lower BMD in prepubertal JRA patients compared with healthy controls (18,39,40). However, a significant proportion of our JRA study population had TB BMD that was at least 1 SD below normal, which permitted univariate and multivariate comparisons to be performed.…”

Section: Discussioncontrasting

confidence: 55%

Predictors of total body bone mineral density in non‐corticosteroid‐treated prepubertal children with juvenile rheumatoid arthritis

Specker

et al. 1997

Arthritis & Rheumatism

104

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Objective. To determine the extent of significant osteopenia in prepubertal patients with juvenile rheumatoid arthritis (JRA) not treated with corticosteroids and to identify variables that are highly related to bone mineralization in this population.Methods. In a cross-sectional study, 48 JRA patients and 25 healthy control subjects ages 4.6-11.0 years were evaluated. Total body bone mineral density (TB BMD) was determined by Hologic dual energy x-ray absorptiometry. All patients were prepubertal (Tanner stage 1 or 11) and had never taken corticosteroids. For comparison, JRA patients were divided into c'lo~7' TB BMD (Z score 5-1) or "normal" TB BMD (Z score >-1).Results. The overall mean k SD TB BMD scores did not differ between the JRA subjects (0.75 2 0.06 gm/cm2) and controls (0.73 k 0.07 gm/cm2; P > 0.30).However, 29.2% of the JRA patients had low TB BMD, whereas only 16% would be expected to have low TB BMD based on the standard normal distribution (goodness of fit 2 = 4.84, P = 0.01). The mean Z score for the JRA patients with low TB BMD was -1.43, and for those with normal TB BMD, it was 0.32. The JRA subjects with low TB BMD were significantly younger, had more active articular disease, greater physical function limitation, higher erythrocyte sedimentation rate, higher joint count severity score, lower body mass index, lower lean body mass, less participation in organized sports, and more protein and vitamin D in their diet compared with JRA patients with normal TB BMD (all P < 0.05). Using logistic regression, a model including age at JRA onset, Juvenile Arthritis Functional Assessment Report (JAFAR) score, triceps skinfold percentiles, percentage US recommended daily allowance for dietary magnesium intake, and serum 1,25-dihydroxyvitamin D levels was able to accurately segregate 79.6% of the JRA subjects into either the low or normal TB BMD groups (2 = 20.5, P = 0.001).Conclusion. This study demonstrated that in a mildly to moderately ill prepubertal JRA population that had never been exposed to corticosteroids, almost 30% had significantly low TB BMD. The patients with low TB BMD had more active and severe articular disease and greater physical function limitation. Disease-related parameters in JRA appear to exert a negative effect on bone mineralization even in prepubertal children, which can be demonstrated despite the exclusion of corticosteroid-treated patients.

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“…Bianchi et al showed the deficiency, malabsorption and disruption of hepatic synthesis of vitamin D in children with JIA who were treated with glucocorticoids. 26 In the same study, after 1 year during which the patients were not given any therapy, serum vitamin D levels were found to be low and parathyroid hormone (PTH) levels were found to be high. As a result, radial BMD was reduced and the expected increase in height was not observed.…”

Section: Discussionmentioning

confidence: 93%