Growth Hormone Increases Final Height in Patients with Juvenile Idiopathic Arthritis: Data from a Randomized Controlled Study

Bechtold, Susanne; Ripperger, P.; Pozza, Robert Dalla; Bonfig, Walter; Häfner, R.; Michels, H.; Schwarz, Hans

doi:10.1210/jc.2007-0544

Cited by 62 publications

(47 citation statements)

References 17 publications

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“…Only 4 of 18 patients (22%) reached a final height within their target height range. Multiple regression analyses revealed that the standardized height gain was most influenced by mean erythrocyte sedimentation rate, mean C-reactive protein level and mean prednisolone dose (cumulative R 2 with 0.67, p < 0.05) [9]. The tremendous height SDS loss during the prepubertal years in this patient group is comparable to retrospective data reported by Simon et al [1].…”

Section: Growth In Patients With Jiasupporting

confidence: 72%

Natural History of Growth and Body Composition in Juvenile Idiopathic Arthritis

Bechtold¹,

Roth

2009

Horm Res Paediatr

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Background: In patients with juvenile idiopathic arthritis (JIA), growth impairment and altered body composition, including disturbed skeletal development, are well-known long-term complications. Data on longitudinal growth in patients with systemic and polyarticular JIA reveal growth impairment in the active phases of the disease. With reduction in disease activity and lower glucocorticoid (GC) doses, some patients experience ‘catch-up’ growth; however, many have only a slight improvement in height standard deviation during puberty or after cessation of GC treatment. The consequence is a final height below the 3rd percentile and below the genetic height potential. Although few studies have specifically addressed body composition in children with JIA, studies on the development of bone mass have described notable deficits in both GC-treated and GC-naïve children. In recent years, the deficits in bone mass have been related, in part, to the deficits in muscle mass, which are prevalent in these patients. Conclusions: The major goal for physicians caring for patients with JIA is optimal disease control while maintaining normal growth. Early recognition of patients who develop prolonged growth disturbances and altered body composition is important as these abnormalities contribute to long-term morbidity and need to be addressed both diagnostically and therapeutically when treating children with JIA.

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Section: Growth In Patients With Jiasupporting

confidence: 72%

Natural History of Growth and Body Composition in Juvenile Idiopathic Arthritis

Bechtold¹,

Roth

2009

Horm Res Paediatr

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“…In another study, GH treatment was reported to be most effective in rescuing bone growth in those childhood JIA patients with moderate disease activity (Bechtold et al 2007). …”

Section: Prevention Of Growth Retardation Caused By Chronic Inflammationmentioning

confidence: 98%

RECENT RESEARCH ON THE GROWTH PLATE: Impact of inflammatory cytokines on longitudinal bone growth

Sederquist¹,

Fernandez-Vojvodich²,

Zaman³

et al. 2014

Journal of Molecular Endocrinology

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Children with inflammatory diseases usually display abnormal growth patterns as well as delayed puberty. This is a result of several factors related to the disease itself, such as malnutrition, hypercortisolism, and elevated levels of pro-inflammatory cytokines. These factors in combination with glucocorticoid treatment contribute to growth retardation during chronic inflammation by systemically affecting the major regulator of growth, the GH/IGF1 axis. However, recent studies have also shown evidence of a direct effect of these factors at the growth plate level. In conditions of chronic inflammation, pro-inflammatory cytokines are upregulated and released into the circulation. The most abundant of these, tumor necrosis factor a, interleukin 1b (IL1b), and IL6, are all known to directly act on growth plate cartilage to induce apoptosis and thereby suppress bone growth. Both clinical and experimental studies have shown that growth retardation can partly be rescued when these cytokines are blocked. Therefore, therapy modulating the local actions of these cytokines may be effective for preventing growth failure in patients with chronic inflammatory disorders. In this review, we report the current knowledge of inflammatory cytokines and their role in regulating bone growth.

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“…Corticosteroid consumption was part of the secondary outcome measures in 25 trials (18.0%). A statistical analysis adjusted for corticosteroid use was described as planned in 2 other reports (1.5%), based on a Cox proportional hazards model adjusted for concomitant use of corticosteroids (10) or exploratory analysis of covariance adjusted for mean daily corticosteroid dosage (11).…”

Section: Resultsmentioning

confidence: 99%

Reporting of corticosteroid use in systemic disease trials: Evidence from a systematic review of the potential impact on treatment effect

Pagnoux¹,

Dechartres

Giraudeau

et al. 2010

Arthritis Care & Research

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Objective. To study how corticosteroid therapy is planned and described in reports of systemic disease trials and estimate the impact of the between-arm difference in corticosteroid dose on treatment effect. Methods. We performed a systematic review of PubMed and Cochrane databases on all reports of randomized systemic disease trials with corticosteroids as a cointervention. Data were extracted on the trial characteristics and results, planning of corticosteroid use, and dose. Success rates were adjusted for corticosteroid use for studies with available data and a binary outcome. Because the exact impact of between-arm differences in corticosteroid dose on success rates is unknown, we tested different values for the impact of a difference of 1 unit (1 mg for daily dosage or 250 mg for cumulative dose at the end of the trial). Results. A total of 139 trials were identified, including 79 investigating lupus and 30 investigating vasculitis. Planned management of corticosteroid use was specified in 101 reports (72.7%), with a fully described tapering scheme in 33 (23.7%). Corticosteroid consumption for each arm was given in 60 reports (43.2%), with a comparison of daily or cumulative dosage at the end of the trial in 32 (23.0%). An attempt to adjust for corticosteroid use was described in 2 (1.5%). With a value of 2.5% for the impact of a 1-unit difference in corticosteroid dose, adjustment yielded changes in success rate differences exceeding 10% in 11 (46%) of the 24 reports analyzed. Conclusion. For systemic disease trials, use of corticosteroids as a cointervention is often inadequately planned and reported and could affect treatment effect.

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Growth Hormone Increases Final Height in Patients with Juvenile Idiopathic Arthritis: Data from a Randomized Controlled Study

Abstract: Our data suggest that long-term GH therapy has a beneficial effect on growth and final height in the majority of growth retarded children with severe forms of JIA.

Cited by 62 publications

References 17 publications

Natural History of Growth and Body Composition in Juvenile Idiopathic Arthritis

Natural History of Growth and Body Composition in Juvenile Idiopathic Arthritis

RECENT RESEARCH ON THE GROWTH PLATE: Impact of inflammatory cytokines on longitudinal bone growth

Reporting of corticosteroid use in systemic disease trials: Evidence from a systematic review of the potential impact on treatment effect

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