Multicenter Study

. 2017 Aug 22;15(1):68.

doi: 10.1186/s12969-017-0196-7.

Growth and weight gain in children with juvenile idiopathic arthritis: results from the ReACCh-Out cohort

Jaime Guzman^{1

2}, Tristan Kerr³, Leanne M Ward⁴, Jinhui Ma⁴, Kiem Oen⁵, Alan M Rosenberg⁶, Brian M Feldman⁷, Gilles Boire⁸, Kristin Houghton⁹, Paul Dancey¹⁰, Rosie Scuccimarri¹¹, Alessandra Bruns⁸, Adam M Huber¹², Karen Watanabe Duffy⁴, Natalie J Shiff¹³, Roberta A Berard¹⁴, Deborah M Levy⁷, Elizabeth Stringer¹², Kimberly Morishita⁹, Nicole Johnson¹⁵, David A Cabral⁹, Maggie Larché¹⁶, Ross E Petty⁹, Ronald M Laxer⁷, Earl Silverman⁷, Paivi Miettunen¹⁵, Anne-Laure Chetaille¹⁷, Elie Haddad¹⁸, Lynn Spiegel⁷, Stuart E Turvey⁹, Heinrike Schmeling¹⁵, Bianca Lang¹², Janet Ellsworth¹⁹, Suzanne E Ramsey¹², Johannes Roth⁴, Sarah Campillo¹¹, Susanne Benseler¹⁵, Gaëlle Chédeville¹¹, Rayfel Schneider⁷, Shirley M L Tse⁷, Roxana Bolaria²⁰, Katherine Gross²⁰, Debbie Feldman²¹, Bonnie Cameron⁷, Roman Jurencak⁴, Jean Dorval¹⁷, Claire LeBlanc¹¹, Claire St Cyr¹⁸, Michele Gibbon⁴, Rae S M Yeung⁷, Ciarán M Duffy⁴, Lori B Tucker⁹

Affiliations

¹ From British Columbia Children's Hospital and University of British Columbia, Vancouver, Canada. jguzman@cw.bc.ca.
² Division of Pediatric Rheumatology, BC Children's Hospital, 4500 Oak St, Suite K4-122, Vancouver, BC, V6H 3N1, Canada. jguzman@cw.bc.ca.
³ Division of Pediatric Rheumatology, BC Children's Hospital, 4500 Oak St, Suite K4-122, Vancouver, BC, V6H 3N1, Canada.
⁴ Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada.
⁵ Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.
⁶ Royal University Hospital and University of Saskatchewan, Saskatoon, Canada.
⁷ Hospital for Sick Children and University of Toronto, Toronto, Canada.
⁸ Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Canada.
⁹ From British Columbia Children's Hospital and University of British Columbia, Vancouver, Canada.
¹⁰ Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John, 's, Canada.
¹¹ McGill University Health Centre and McGill University, Montreal, Canada.
¹² IWK Health Centre and Dalhousie University, Halifax, Canada.
¹³ Shands Children's Hospital and University of Florida, Gainesville, USA.
¹⁴ London Health Sciences Centre and Western University, London, Canada.
¹⁵ Alberta Children's Hospital and University of Calgary, Calgary, Canada.
¹⁶ McMaster University, Hamilton, Canada.
¹⁷ Centre Hospitalier Universitaire de Laval and Université Laval, Quebec, Canada.
¹⁸ Centre Hospitalier Universitaire Ste. Justine and Université de Montréal, Montréal, Canada.
¹⁹ Stollery Children's Hospital and University of Alberta, Edmonton, Canada.
²⁰ Department of Pediatrics University of British Columbia, Vancouver, Canada.
²¹ Université de Montréal, Montréal, Canada.

PMID: 28830457
PMCID: PMC5567720
DOI: 10.1186/s12969-017-0196-7

Multicenter Study

Growth and weight gain in children with juvenile idiopathic arthritis: results from the ReACCh-Out cohort

Jaime Guzman et al. Pediatr Rheumatol Online J. 2017.

. 2017 Aug 22;15(1):68.

doi: 10.1186/s12969-017-0196-7.

Authors

Affiliations

¹ From British Columbia Children's Hospital and University of British Columbia, Vancouver, Canada. jguzman@cw.bc.ca.
² Division of Pediatric Rheumatology, BC Children's Hospital, 4500 Oak St, Suite K4-122, Vancouver, BC, V6H 3N1, Canada. jguzman@cw.bc.ca.
³ Division of Pediatric Rheumatology, BC Children's Hospital, 4500 Oak St, Suite K4-122, Vancouver, BC, V6H 3N1, Canada.
⁴ Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada.
⁵ Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.
⁶ Royal University Hospital and University of Saskatchewan, Saskatoon, Canada.
⁷ Hospital for Sick Children and University of Toronto, Toronto, Canada.
⁸ Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Canada.
⁹ From British Columbia Children's Hospital and University of British Columbia, Vancouver, Canada.
¹⁰ Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John, 's, Canada.
¹¹ McGill University Health Centre and McGill University, Montreal, Canada.
¹² IWK Health Centre and Dalhousie University, Halifax, Canada.
¹³ Shands Children's Hospital and University of Florida, Gainesville, USA.
¹⁴ London Health Sciences Centre and Western University, London, Canada.
¹⁵ Alberta Children's Hospital and University of Calgary, Calgary, Canada.
¹⁶ McMaster University, Hamilton, Canada.
¹⁷ Centre Hospitalier Universitaire de Laval and Université Laval, Quebec, Canada.
¹⁸ Centre Hospitalier Universitaire Ste. Justine and Université de Montréal, Montréal, Canada.
¹⁹ Stollery Children's Hospital and University of Alberta, Edmonton, Canada.
²⁰ Department of Pediatrics University of British Columbia, Vancouver, Canada.
²¹ Université de Montréal, Montréal, Canada.

PMID: 28830457
PMCID: PMC5567720
DOI: 10.1186/s12969-017-0196-7

Abstract

Background: With modern treatments, the effect of juvenile idiopathic arthritis (JIA) on growth may be less than previously reported. Our objective was to describe height, weight and body mass index (BMI) development in a contemporary JIA inception cohort.

Methods: Canadian children newly-diagnosed with JIA 2005-2010 had weight and height measurements every 6 months for 2 years, then yearly up to 5 years. These measurements were used to calculate mean age- and sex-standardized Z-scores, and estimate prevalence and cumulative incidence of growth impairments, and the impact of disease activity and corticosteroids on growth.

Results: One thousand one hundred forty seven children were followed for median 35.5 months. Mean Z-scores, and the point prevalence of short stature (height < 2.5th percentile, 2.5% to 3.4%) and obesity (BMI > 95th percentile, 15.8% to 16.4%) remained unchanged in the whole cohort. Thirty-three children (2.9%) developed new-onset short stature, while 27 (2.4%) developed tall stature (>97.5th percentile). Children with systemic arthritis (n = 77) had an estimated 3-year cumulative incidence of 9.3% (95%CI: 4.3-19.7) for new-onset short stature and 34.4% (23-49.4) for obesity. Most children (81.7%) received no systemic corticosteroids, but 1 mg/Kg/day prednisone-equivalent maintained for 6 months corresponded to a drop of 0.64 height Z-scores (0.56-0.82) and an increase of 0.74 BMI Z-scores (0.56-0.92). An increase of 1 in the 10-cm physician global assessment of disease activity maintained for 6 months corresponded to a drop of 0.01 height Z-scores (0-0.02).

Conclusions: Most children in this modern JIA cohort grew and gained weight as children in the general population. About 1 in 10 children who had systemic arthritis, uncontrolled disease and/or prolonged corticosteroid use, had increased risk of growth impairment.

Keywords: Corticosteroids; Growth; Juvenile arthritis; Obesity.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by research ethics boards at each participating institution. Parents provided informed written consent, and patients provided assent where appropriate.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Subject eligibility and disposition

**Fig. 2**
Smoothed trajectories of mean Z-scores. Shown are trajectories of (a) height, (b) weight, and (c) BMI for each JIA category in the 3 years after diagnosis. Panel (d) shows Z-score trajectories for the whole cohort. Trajectories of the mean Z-score were charted using locally weighted scatter plot smoothing with a band width of 0.6. The black dashed horizontal line represents healthy growth standards

**Fig. 3**
Point prevalence of short stature and obesity in the whole cohort. Shown are the point prevalences of a) short stature and b) obesity in the whole cohort at every study visits for the 3 years after enrolment, and after excluding children who received corticosteroids. The vertical lines represent 95%CI

See this image and copyright information in PMC

References

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Growth and weight gain in children with juvenile idiopathic arthritis: results from the ReACCh-Out cohort

Affiliations

Growth and weight gain in children with juvenile idiopathic arthritis: results from the ReACCh-Out cohort

Authors

Affiliations

Abstract

Conflict of interest statement

Ethics approval and consent to participate

Consent for publication

Competing interests

Figures

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical