Growth and weight gain in children with juvenile idiopathic arthritis: results from the ReACCh-Out cohort

Abstract

Background: With modern treatments, the effect of juvenile idiopathic arthritis (JIA) on growth may be less than previously reported. Our objective was to describe height, weight and body mass index (BMI) development in a contemporary JIA inception cohort. Methods: Canadian children newly-diagnosed with JIA 2005-2010 had weight and height measurements every 6 months for 2 years, then yearly up to 5 years. These measurements were used to calculate mean age-and sex-standardized Z-scores, and estimate prevalence and cumulative incidence of growth impairments, and the impact of disease activity and corticosteroids on growth. Results: One thousand one hundred forty seven children were followed for median 35.5 months. Mean Z-scores, and the point prevalence of short stature (height < 2.5th percentile, 2.5% to 3.4%) and obesity (BMI > 95th percentile, 15.8% to 16. 4%) remained unchanged in the whole cohort. Thirty-three children (2.9%) developed new-onset short stature, while 27 (2.4%) developed tall stature (>97.5th percentile). Children with systemic arthritis (n = 77) had an estimated 3-year cumulative incidence of 9.3% (95%CI: 4.3-19.7) for new-onset short stature and 34.4% (23-49.4) for obesity. Most children (81.7%) received no systemic corticosteroids, but 1 mg/Kg/day prednisone-equivalent maintained for 6 months corresponded to a drop of 0.64 height Z-scores (0.56-0.82) and an increase of 0.74 BMI Z-scores (0.56-0.92). An increase of 1 in the 10-cm physician global assessment of disease activity maintained for 6 months corresponded to a drop of 0.01 height Z-scores (0-0.02). Conclusions: Most children in this modern JIA cohort grew and gained weight as children in the general population. About 1 in 10 children who had systemic arthritis, uncontrolled disease and/or prolonged corticosteroid use, had increased risk of growth impairment.

Treatment to Target Using Recombinant Interleukin‐1 Receptor Antagonist as First‐Line Monotherapy in New‐Onset Systemic Juvenile Idiopathic Arthritis: Results From a Five‐Year Follow‐Up Study

“…The percentage of patients with inactive disease after 1 year of therapy in our study was >2‐fold higher than the percentages in other prospective trials using biologic agents as second‐ or third‐line therapy in systemic JIA . Furthermore, the incidence of articular damage, growth failure, obesity, and functional limitations was ~3 times lower than in recent observational cohorts .…”

“…Unfortunately, the first trials demonstrated completely inactive disease in only 30% of patients after the first year of therapy, and biologic therapy was often combined with other glucocorticoids and/or other DMARDs. In recent inception cohorts, ~50% of the patients with new‐onset disease had inactive disease after 1 year and 70% after 3 years of therapy . In addition, 50–60% of patients with systemic JIA received long‐term systemic glucocorticoids, which are associated with severe and longstanding side effects such as growth failure and obesity .…”

“…In recent inception cohorts, ~50% of the patients with new‐onset disease had inactive disease after 1 year and 70% after 3 years of therapy . In addition, 50–60% of patients with systemic JIA received long‐term systemic glucocorticoids, which are associated with severe and longstanding side effects such as growth failure and obesity . Hence, there is a strong need for a more effective therapeutic approach with fewer side effects.…”

Prognosis, complications and treatment response in systemic juvenile idiopathic arthritis patients: A single‐center experience

“…growth velocity. 33 The most optimal way to prevent complications is to use steroids as short as possible, in the lowest acceptable doses.…”

“…Supportive treatment with calcium and vitamin D should not be underestimated in the prevention of disease complications. 33 The frequency of growth retardation in sJIA has been reported as 10%-20% in different studies. 34 In a national sJIA cohort from Germany, the percentage of growth retardation was 23%.…”