Abstract
Objective
To investigate growth, development and bone mineralization of children with juvenile idiopathic arthritis (JIA).
Methods
Thirty patients between 4–17 years of age (mean 11.34 ± 3.88) resistant to therapy were studied. Enrollment began in November 1999 and continued through November 2004 and children with chronic disease were excluded. Data like height, weight, medications and acute phase reactants were obtained from medical records. On study-visit, puberty was assessed by physical examination and bone mineral density (BMD) was measured. Serum Ca, P, ALP, insulin-like growth factor-1 (IGF-1) and urinary Ca/Cr and hydroxyproline /Cr levels were measured. Results were compared with the control group that consisted of 30 cases of similar age and gender.
Results
Patients with JIA had decreased height standard deviation score (SDS) and growth retardation. BMD of the cases in the study group was lower than the control group (p<0.05). Patients who were at younger age at the onset of the disease had lower BMD. Among the drugs, only steroids had a negative effect on growth. Serum IGF-1 levels of the study group were significantly lower than the control group (p<0.0001).
Conclusion
Early diagnosis and suppression of disease activity is important in prevention of osteoporosis and growth retardation in children with JIA. BMD has to be measured yearly in patients for accurate diagnosis of osteoporosis. Vitamin D and Ca-rich nutrition with promotion of physical activity and controlled use of steroids may protect the children against bone loss.
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References
Cassidy JT, Petty RE. Juvenile rheumatoid arthritis. In Cassidy JT, Petty RE, eds. Textbook of Pediatric Rheumatology, 3rd ed. London; W.B. Saunders Co, 1995; 133–223.
Woo PMM. Growth retardation and osteoporosis in juvenile chronic arthritis. Clin Exp Rheumatol 1994; 12: 87–90.
Cassidy JT, Hillman LS. Abnormalities in skeletal growth in children with juvenile rheumatoid arthritis. Rheum Dis Clin North Am 1997; 23: 499–522.
Badley BW, Ansell BM. Fractures in Still’s disease. Ann Rheum Dis 1960; 19: 135–142.
Landin LA. Fracture patterns in children. Analysis of 8,682 fractures with special reference to incidence, etiology and secular changes in a Swedish urban population 1950–1979. Acta Orthop Scand 1983; 202: 1–109.
Giannini HE, Cawkwell GT. Drug treatment in children with juvenile rheumatoid arthritis. Pediatr Clin North Am 1995; 42: 1099–1125.
Cassidy JT, Langman CB, Allen SH et al. Bone mineral metabolism in children with juvenile rheumatoid arthritis. Pediar Clin North Am 1995; 42: 1017–1033.
Warady BD, Lindsley CB, Robinson FG et al. The effect of nutritional supplementation on bone mineral status of children with rheumatic diseases on corticosteroid therapy. J Rheumatol 1994; 21: 530–535.
Varonos S, Ansell BM, Reeve J. Vertebral collapse in juvenile chronic arthritis: its relationship with glucocorticoid therapy. Calcif Tissue Int 1987; 41: 75–78.
Trotter M, Hixon BB. Sequential changes in weight, density, and percentage ash weight of human skeletons from an early fetal period through old age. Anat Rec 1974; 179: 1–18.
Garcia-Consuegra Molina J, Merino Munoz R, Lama More R et al. Growth in children with juvenile idiopathic arthritis. An Pediatr (Barc) 2003; 58: 529–537.
Bechtold S, Ripperger P, Hafner R. Growth hormone improves height in patients with juvenile idiopathic arthritis: 4-year data of a controlled study. J Pediatr 2003; 143: 512–519.
Bailey DA, Wedge JH, McCulloch RG et al. Epidemiology of fractures of the distal end of the radius in children as associated with growth. J Bone Joint Surg Am 1989; 71: 1225–1231.
Blimkie CJ, Lefevre J, Beunen GP et al. Fractures, physical activity, and growth velocity in adolescent Belgian boys. Med Sci Sports Exerc 1993; 25: 801–808.
Chan GM, Hess M, Hollis J et al. Bone mineral status in childhood accidental fractures. Am J Dis Child 1984; 138: 569–570.
Cummings SR, Black DM, Nevitt MC et al. Appendicular bone density and age predict hip fracture in women. The Study of Osteoporotic Fractures Research Group. JAMA 1990; 263: 665–668.
Elsasser U, Wilkins B, Hesp R. Bone rarefaction and crush fractures in juvenile chronic arthritis. Arch Dis Child 1982; 57: 377–380.
Joffe I, Epstein S. Osteoporosis associated with rheumatoid arthritis: Pathogenesis and management. Semin Arthritis Rheum 1991; 20: 256–272.
Pepmueller PH, Cassidy JT, Allen SH et al. Bone mineralization and bone mineral metabolism in children with juvenile rheumatoid arthritis. Arthritis Rheum 1996; 39: 746–757.
Geusens P, Cantatore F, Nijs J et al. Heterogeneity of growth of bone in children at the spine, radius and total skeleton. Growth Dev Aging 1991; 55: 249–256.
Hopp R, Degan J, Gallagher JC et al. Estimation of bone mineral density in children with juvenile rheumatoid arthritis. J Rheumatol 1991; 18: 1235–1239.
Lovell DJ, Gregg D, Heubi J. Bone mineralization in JRA patients. Arthritis Rheum 1986; 29: 567–583.
Delmas PD. Biochemical markers of bone turnover: methodology and clinical use in osteoporosis. Am J Med 1991; 91: 59–63.
Katzman DK, Bachrach LK, Carter DR et al. Clinical, and anthropometric correlates of bone mineral acquisition in healthy adolescent girls. J Clin Endocrinol Metab 1991; 73: 1332–1339.
Reed A, Haugen M, Pachman LM et al. 25-Hydroxyvitamin D therapy in children with active juvenile rheumatoid arthritis: short-term effects on serum osteocalcin levels and bone mineral density. J Pediatr 1991; 119: 657–660.
Bianchi ML, Bardare M, Caraceni MP. Bone metabolism in juvenile rheumatoid arthritis. Bone Miner 1990; 9: 153–162.
Sosa Henriquez M, Torres Ramirez A, Dominguez Cabrera C, et al. Genetic polymorphisim of vitamin D receptor and osteoporosis. Med Clin (Barc) 1998; 110: 646–650.
Weaver CM, Peacock M, Martin BR et al. Quantification of biochemical markers of bone turnover by kinetic measures of bone formation and resorption in young healthy females. J Bone Miner Res 1997; 12: 1714–1720.
Hillman L, Cassidy JT, Johnson L et al. Vitamin D metabolism and bone mineralization in children with juvenile rheumatoid arthritis. J Pediatr 1994; 124: 910–916.
Matuszkiewicz-Rowinska J, Niemczyk S, Przedlacki J et al. Effect of salmon calcitonin on bone mineral density and calcium-phosphate metabolism in chronic hemodialysis patients with secondary hyperparathyroidism. Pol Arch Med Wewn 2004;112: 797–803.
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Okumus, O., Erguven, M., Deveci, M. et al. Growth and bone mineralization in patients with juvenile idiopathic arthritis. Indian J Pediatr 75, 239–243 (2008). https://doi.org/10.1007/s12098-008-0052-3
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DOI: https://doi.org/10.1007/s12098-008-0052-3