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The dual role of body mass index on Juvenile Idiopathic Arthritis course: a pediatric experience

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Abstract

Despite the well-known role of obesity as risk factor for Juvenile Idiopathic Arthritis (JIA) severity, emerging but limited evidence suggested a similar role for underweight. We investigated the role of body mass index (BMI) across its full spectrum in a cohort of children with JIA.

We retrospectively studied 113 children with JIA classified according to the International League of Association for Rheumatology (ILAR) criteria attending our Rheumatology Clinic. The patients underwent a comprehensive evaluation including both clinical and biochemical assessments. According to BMI Z-score, the cohort was divided into five groups as underweight, normal weight, overweight (OW), obesity (OB), and severe OB. Disease activity was calculated by Juvenile Arthritis Disease Activity Score 10 (JADAS-10) joint reduced count and relapses were defined according to Wallace criteria.

The mean age of the cohort was 7.43 ± 4.03 years. The prevalence of underweight, normal weight, OW, OB, and severe OB was 7.2%, 54.1%, 10.8%, 17.1%, and 10.8%, respectively. Significant higher ferritin levels and erythrocyte sedimentation rate values were found in patients with severe OB and underweight compared to subjects belonging to normal weight, OW, and OB groups. A greater JADAS-10 score was observed in underweight patients and in those with severe OB than other groups. The relapse rate was higher in patients with severe OB and underweight compared to other groups.

          Conclusions: Both underweight and OB might negatively affect JIA course. Weight control is fundamental in children with JIA to avoid a more unfavourable course of the disease.

What is Known:

• Obesity represents a well-known risk factor for JIA severity.

• The role of underweight in children with JIA is still poorly explored.

What is New:

• As observed in children with obesity, underweight young patients with JIA seem to experience a more severe JIA course.

• Healthy lifestyle promotion in children with JIA is a crucial step in the management of the disease.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

BMI:

Body mass index

DMARDs:

Disease-modifying anti-rheumatic drugs

ILAR:

International League of Association for Rheumatology

JIA:

Juvenile Idiopathic Arthritis

JADAS-10:

Juvenile Arthritis Disease Activity Score 10

NSAIDs:

Non-steroidal anti-inflammatory drugs

OB:

Obesity

OW:

Overweight

RA:

Rheumatoid arthritis

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Acknowledgements

The authors are grateful to all patients and their families.

Author information

Authors and Affiliations

  1. Department of Woman, Child, and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Maria Francesca Gicchino, Pierluigi Marzuillo, Rosa Melone, Sarah Zarrilli, Emanuele Miraglia del Giudice, Alma Nunzia Olivieri & Anna Di Sessa

Authors
  1. Maria Francesca Gicchino
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  2. Pierluigi Marzuillo
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  3. Rosa Melone
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  4. Sarah Zarrilli
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  5. Emanuele Miraglia del Giudice
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  6. Alma Nunzia Olivieri
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  7. Anna Di Sessa
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Contributions

MFG and ADS drafted the paper. EMDG, ANO, and ADS participated in the conception and the design of the study. SZ, RM, and PM examined the patients and collected anthropometric and biochemical data. ADS, MFG, and PM performed data analysis. ADS, EMDG, ANO, and PM supervised the design and execution of the study. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Anna Di Sessa.

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Competing interests

The authors declare no competing interests.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Research Ethical Committee of University of Campania “Luigi Vanvitelli” (protocol code 834/2016).

Consent to participate

Informed consent was obtained from all individual participants included in the study. Patients’ data were treated to guarantee confidentiality.

Competing interest

The authors declare no competing interests.

Additional information

Communicated by Peter de Winter

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Gicchino, M., Marzuillo, P., Melone, R. et al. The dual role of body mass index on Juvenile Idiopathic Arthritis course: a pediatric experience. Eur J Pediatr 183, 809–813 (2024). https://doi.org/10.1007/s00431-023-05348-8

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