About one in three children with juvenile idiopathic arthritis may experience growth or pubertal disturbances, potentially linked to hormone disruptions and prolonged disease activity, according to new study results.
Investigators followed 107 children with JIA over a 1-year period. They observed that 20.6% were shorter than expected for their age, 22.4% were underweight, and 25.2% had a low body mass index (BMI). Stunted growth was more common in children with earlier disease onset and elevated growth hormone (GH) levels—suggesting possible GH resistance.
Although hormone levels were often abnormal in children with poor growth, they did not consistently correlate with height measurements. This pattern may indicate GH resistance, where the body does not respond adequately to circulating GH despite normal or elevated levels, noted Sayan Mukherjee and colleagues.
Underweight children tended to have longer disease duration and more extra-articular damage. Those with low BMI had higher disease activity, poorer physical functioning, and lower quality of life scores. Elevated GH and reduced levels of IGFBP3—a protein that transports insulin-like growth factors—were also more frequent in this group.
Most children had age-appropriate pubertal development. Only 2.8% had delayed puberty or menarche. Among girls, lower estradiol levels were significantly associated with corticosteroid use lasting more than three months. “Girls with low estradiol level had longer exposure to corticosteroids,” noted Mukherjee, of the Department of Clinical Immunology and Rheumatology, King George’s Medical University, Lucknow, India, and colleagues. In boys, nearly half had low testosterone levels, but no significant associations were found with disease severity or steroid use.
By the end of the follow-up period, 74% of patients achieved low disease activity, and nearly half met clinical remission criteria. Despite these improvements ,investigators noted the importance of continued monitoring of growth and sexual development, particularly in patients with early-onset or long-standing disease.
Deviations in growth and weight may not be fully explained by inflammation or steroid exposure alone. Other contributing factors likely include nutrition, physical activity, and hormone regulation.
Importantly, no strong correlation between children’s height and mid-parental height was found, suggesting that stunting was primarily disease-related rather than genetic.
"This study opens up the alleys for further translational research regarding hormonal dynamics in JIA. In clinical practice, not only pharmacotherapy, but holistic approach to address the concerns of growth and development in young child may improve over-all outcome and well-being of the child with JIA," the researchers noted.
Treating arthritis alone may not address the full spectrum of health challenges in children with JIA. Comprehensive care may require regular hormonal assessments, nutritional support, and monitoring of physical development.
The authors reported no conflicts of interest.
Source: Pediatric Rheumatology