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Growth hormone in JIA

Clinical bottom line

Growth hormone treatment in children with juvenile idiopathic arthritis led to a continuous catch up growth over a period of four years.


Background

Disturbed growth occurs frequently in children with juvenile idiopathic arthritis, and reduced final height could be a consequence of this. This paper reports on the use of growth hormone in a small clinical trial.

Reference

S Bechtold et al. Growth hormone improves height in patients with juvenile idiopathic arthritis: 4-year data of a controlled study. Journal of Pediatrics 2003 143: 512-519.


Study

Forty-six prepubertal children with an SD score for height of -2 or below, a height velocity below the 25th percentile in the year before the start of treatment, or both, and with severe systemic or nonsystemic polyarticular juvenile idiopathic arthritis formed the population studied. All were tested for growth hormone deficiency, and nine were considered deficient. The remaining 37 were randomly allocated to receive growth hormone or not. Observations on height and other outcomes extended over four years, with measurements at three or six month intervals.

Results

The analysis is restricted to 18 children on therapy (12 randomised with data, and six on therapy because of growth hormone deficiency, and 20 allocated to no therapy). There were no significant differences at the start of treatment. All were on glucocorticoid therapy at the the start.

In the first year, when all children were prepubertal, the height velocity of the treated children increased from 2.9 cm/year to 7.2 cm/year, and it remained unchanged in the control group (2.6 and 3.3 cm/year respectively). After this time some children entered puberty, but at the same rate in both groups. In comparison with normal children, those treated with growth hormone was better.

Prednisolone dose influenced growth rate. Those children with higher prednisolone doses had lower growth rates, especially when not on growth hormone.

Comment

Growth hormone treatment in children with juvenile idiopathic arthritis led to a continuous catch up growth over a period of four years. While this trial was small, and complicated by having a number of children with diagnosed growth hormone deficiency, it is hard to consider that any future trial will be done comparing growth hormone with no treatment.