Growth and puberty in children with juvenile idiopathic arthritis

Abstract

Juvenile Idiopathic Arthritis is one of the most prevalent chronic diseases in children, with an annual incidence of 2–20 cases per 100,000 and a prevalence of 16–150 per 100,000. It is associated with several complications that can cause short-term or long-term disability and reduce the quality of life. Among these, growth and pubertal disorders play an important role. Chronic inflammatory conditions are often associated with growth failure ranging from slight decrease in height velocity to severe forms of short stature. The prevalence of short stature in JIA varies from 10.4% in children with polyarticular disease to 41% of patients with the systemic form, while oligoarthritis is mostly associated with localized excessive bone growth of the affected limb, leading to limb dissymmetry. The pathogenesis of growth disorders is multifactorial and includes the role of chronic inflammation, long-term use of corticosteroids, undernutrition, altered body composition, delay of pubertal onset or slow pubertal progression. These factors can exert a systemic effect on the GH/IGF-1 axis and on the GnRH-gonadotropin-gonadic axis, or a local influence on the growth plate homeostasis and function. Although new therapeutic options are available to control inflammation, there are still 10–20% of patients with severe forms of the disease who show continuous growth impairment, ending in a short final stature. Moreover, delayed puberty is associated with a reduction in the peak bone mass with the possibility of concomitant or future bone fragility. Monitoring of puberty and bone health is essential for a complete health assessment of adolescents with JIA. In these patients, an assessment of the pubertal stage every 6 months from the age of 9 years is recommended. Also, linear growth should be always evaluated considering the patient’s bone age. The impact of rhGH therapy in children with JIA is still unclear, but it has been shown that if rhGH is added at high dose in a low-inflammatory condition, post steroids and on biologic therapy, it is able to favor a prepubertal growth acceleration, comparable with the catch-up growth response in GH-deficient patients. Here we provide a comprehensive review of the pathogenesis of puberty and growth disorders in children with JIA, which can help the pediatrician to properly and timely assess the presence of growth and pubertal disorders in JIA patients.

Quantitative proteomics analysis to assess protein expression levels in the ovaries of pubescent goats

“…In this study, IGF-1 expression levels were also significantly upregulated in the ovaries of goats at puberty. IGF-1, a polypeptide hormone, is an important modulator of GH activity, and it plays a pivotal role in cell differentiation and proliferation [38] as well as in bone growth and development [39]. In addition, in the developing central nervous system, IGF-1 mediates changes in morphology, synaptic efficacy, and cellular organization, enabling cells of the central nervous system to respond to continuous external and internal stimuli [40].…”

Bone Health in Children with Rheumatic Disorders: Focus on Molecular Mechanisms, Diagnosis, and Management

“…Chronic inflammatory diseases are often associated with growth delay, ranging from a minimal decrease in HV to severe short stature [ 111 ]. Growth disorders have a multifactorial pathogenesis, including the role of the chronic inflammatory state, long-term use of GCs, malnutrition and malabsorption, physical inactivity, and disorders of pubertal onset.…”

Why and How Should We Assess the Cardiovascular Risk in Patients with Juvenile Idiopathic Arthritis? A Single-Centre Experience with Carotid Intima-Media Measurements

“…Despite the undeniable progress in therapeutic possibilities for patients diagnosed with the most common arthropathy in childhood, juvenile idiopathic arthritis (JIA), a substantial proportion of patients develop mild to moderate long-term disability with a decreased health-related quality of life [ 1 ]. Similarly to other autoimmune juvenile-onset illnesses, including type 1 diabetes and systemic lupus erythematosus, JIA patients are deemed to be at higher risk of developing cardiovascular disease (CVD) during the adulthood [ 2 ].…”