Effects of Growth Hormone Treatment on Growth in Children with Juvenile Idiopathic Arthritis

Abstract

Background: Several therapeutic trials have been conducted over the past decade to evaluate the role of exogenous growth hormone (GH) as a means of correcting the growth deficiency seen in children with juvenile idiopathic arthritis (JIA). Early studies showed the benefit of GH treatment with respect to final height in patients with JIA. Of 13 patients receiving GH, 84% (11 patients) achieved a final height within their target range compared with only 22% (4 of 18 patients) of untreated patients. There are, however, factors that may limit the statural gains achieved with GH therapy including severe inflammation, severe statural deficiency at GH therapy initiation, long disease duration and delayed puberty. Data on the efficacy of GH replacement therapy in children with JIA and factors that influence the statural growth response will be reviewed. Conclusions: Results from therapeutic trials show that treatment with GH can decrease the statural deficit that occurs during the active phase of JIA, producing an adult height that is close to the genetically determined target height.

Growth and Chronic Disease

“…Whereas disease activity and the dose of prednisolone have a negative effect, the dose of rhGH has a positive effect on the growth response [60] . Although no adverse effects were observed in these patients, transient glucose intolerance with rhGH reported in a previous study highlights the need to evaluate safety long-term [59] .…”

“…Trials of rhGH in selected children with persistently active JIA and severe growth failure have reported improvements in linear growth after 6 months of treatment [58] as well as a sustained effect for up to 4 years [59,60] . Intervening with rhGH earlier on in the course of the disease is speculated to minimize the significant loss in height, especially in patients treated with corticosteroids [59] .…”

“…Intervening with rhGH earlier on in the course of the disease is speculated to minimize the significant loss in height, especially in patients treated with corticosteroids [59] . A significant increase in height velocity compared to baseline but no change in height SDS were observed in the first 2 years in an open uncontrolled study in 13 exceptionally short corticosteroid-treated patients (mean height -4.6 SDS) [59] . Additional benefits of rhGH proposed from this study were an increase in lean mass and lumbar bone mineral density.…”

Glucocorticoid-Induced osteoporosis: clinical and therapeutic aspects

“…Moreover, combined therapy of rhGH and rhIGF-I counteracted selected negative effects of glucocorticoids on bone in healthy volunteers who received short-term glucocorticoid therapy (29). Observational and controlled studies in children receiving glucocorticoid therapy for juvenile idiopathic arthritis showed that rhGH restored normal height velocity with a concomitant improvement of bone mineralization (30)(31)(32)(33). However, the efficacy of rhGH and rhIGF-I treatment in GIO is controversial and needs to be documented by welldesigned prospective controlled studies.…”

The multiple roles of steroids and anabolic steroids and its relations to cardiovasular and musculoskeletal pathology: a brief review

“…Low dose treatment involves linear growth mainly in pediatric asthmatic cases. Corticosteroids can inhibit mechanisms and organ responsiveness therefore the use of recombinant growth hormones could rehabilitate growth velocity 36 . Furthermore, steroid myopathy is eventuated by high dose corticosteroid treatment combined with sedentary lifestyle.…”