Effects on Growth and Body Composition of Growth Hormone Treatment in Children with Juvenile Idiopathic Arthritis Requiring Steroid Therapy

DOMINIQUE SIMON, NADINE LUCIDARME, ANNE-MARIE PRIEUR, JEAN CHARLES RUIZ, and PAUL CZERNICHOW

ABSTRACT.

Objective. Decreased growth velocity and abnormal body composition including severe osteoporosis are common in glucocorticoid-treated patients with juvenile idiopathic arthritis (JIA). We evaluated the effects of recombinant human growth hormone (GH) given for 3 years on growth velocity, height standard deviation score (SDS), and body composition, together with potential adverse effects on glucose tolerance.

Methods. Thirteen patients received GH (0.46 mg/kg/week) for 3 years. Body composition was assessed by dual-energy x-ray absorptiometry and glucose tolerance by annual oral glucose tolerance tests.

Results. Median growth velocity increased from 2.1 to 6.0 cm/year (p = 0.002) in the first year and remained higher than baseline in the second year of treatment. Height SDS did not change significantly (–4.6 SDS at baseline vs –4.3 SDS at study completion), but the growth response varied markedly across patients. Compared with baseline, lean mass increased by 33%, fat mass remained stable, and lumbar bone mineral density increased by 36.6%. Transient glucose intolerance developed in 6 patients, but glycosylated hemoglobin concentrations did not change significantly and diabetes mellitus did not occur.

Conclusion. Treatment with GH restored linear growth without inducing catch-up growth, significantly improved body composition, and prevented further bone loss. Prolonged followup is needed to assess the benefits of GH and longterm consequences of hyperinsulinism. (J Rheumatol 2003;30:2492-9)

Key Indexing Terms:

JUVENILE IDIOPATHIC ARTHRITIS
GLUCOCORTICOIDS
GROWTH
GROWTH HORMONE TREATMENT
BODY COMPOSITION
GLUCOSE TOLERANCE

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From the Department of Endocrinology and Diabetology, and INSERM Clinical Investigation Center (CIC9202), Robert Debré Teaching Hospital; Department of Immuno-Hematology and Rheumatology, Hôpital Necker-Enfants Malades; and the Department of Radiology, Hôpital Cochin, Paris, France.

D. Simon, MD; N. Lucidarme, MD, Department of Endocrinology and Diabetology; A.M. Prieur, MD, Department of Immuno-Hematology and Rheumatology, Hôpital Necker-Enfants Malades; J.C. Ruiz, MD, Department of Radiology, Hôpital Cochin; P. Czernichow, MD, Department of Endocrinology and Diabetology.

Address reprint requests to Dr. D. Simon, Department of Endocrinology and Diabetology, Hôpital Robert Debré, 48 boulevard Sérurier, 75019 Paris, France. E-mail: dominique.simon@rdb.ap-hop-paris.fr

Submitted December 10, 2002; revision accepted April 17, 2003.

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