Original article
Growth hormone improves height in patients with juvenile idiopathic arthritis: 4-year data of a controlled study

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Abstract

Objective

To evaluate the efficacy and safety of growth hormone treatment in severely growth retarded children with juvenile idiopathic arthritis (JIA) receiving glucocorticoids.

Study design

Children with systemic and polyarticular idiopathic arthritis (22 F, 16 M) with a mean age of 10.1 years were enrolled in this controlled study. Eighteen patients (9 F, 9M; mean age, 10.5 years) received growth hormone in a dose of 0.20 to 0.33 mg/kg body weight per week for 4 years. Twenty patients (13 F, 7 M; mean age, 9.6 years) served as an untreated control group.

Results

Mean improvement in height in the treated group was 1 SD, whereas the patients of the control group lost 0.7 SD. Disease activity markers correlated significantly with the mean growth velocity standard deviation score. In general, children with mild or moderate disease and lower comedication grew and responded better to growth hormone therapy than those with active disease. No adverse events were noted.

Conclusion

Our data suggest that long-term growth hormone therapy has a beneficial effect in children with severe forms of JIA. Further data are needed to confirm the efficacy and safety of growth hormone and its effect on final height.

Section snippets

Patient population and study protocol

Prepubertal children (n = 46) with severe systemic or nonsystemic polyarticular JIA and growth retardation were enrolled within 10 months, fulfilling the International League of Associations of Rheumatologists classification criteria.6 All children had a SD score for height of −2.0 or below, a height velocity below the 25th percentile during the year before the beginning of treatment, or both. At study start, all patients were prepubertal. They had been treated with glucocorticoids on a relative

Patients

Thirty-eight patients were suitable for evaluation (Fig 1). Their characteristics during the study period are shown in Table I.

At start, there was no statistical difference between the groups regarding classification of JIA, age at onset of JIA, duration of illness, daily glucocorticoid dose, cumulative prednisolone dose, age, BA, and GVSDs. Patients of the control group were significantly taller than the patients of the treated group, and there were more girls in the control group. None of the

Discussion

This study shows that GH treatment in JIA led to a continuous catch-up growth over a period of 4 years, resulting in a net height gain of 1.0 SDs. This may translate into an increased final height. The beneficial effect of long-term GH therapy was even more impressive when compared with the control group, consisting of children with similar medical characteristics but initially somewhat taller stature. It could be speculated that the GH-treated children would have had a much poorer outcome

Acknowledgements

We thank Dr Gerlinde Lang and Dr H. Steinkamp, Pharmacia, Erlangen, Germany, for their support.

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Supported by Pharmacia, Erlangen, Germany.

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