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. 2024 Apr-Jun;50(2):207-214.
doi: 10.12865/CHSJ.50.02.05. Epub 2024 Jun 30.

Algorithm for Growth Evaluation in Juvenile Idiopathic Arthritis

Rodica Eremciuc  1   2 , Ninel Revenco  1   2 , Cristian Gheonea  3
Affiliations

Algorithm for Growth Evaluation in Juvenile Idiopathic Arthritis

Rodica Eremciuc et al. Curr Health Sci J. 2024 Apr-Jun.

Abstract

Juvenile Idiopathic Arthritis (JIA) includes a range of inflammatory conditions that exhibit chronic arthritis with various clinical presentations. The disease's heterogeneity leads to different impacts on children's health, both short and long-term. Compromised growth, seen as growth retardation and delayed puberty, is a common complication in children with JIA, severely impacting their quality of life. This impairment is linked to disease duration and activity, with severe cases in systemic and polyarticular subtypes. Literature reports growth retardation incidence from 8% to 41%, but data on pubertal impairment is lacking. Growth in children is influenced by systemic and local mechanisms. Chronic inflammation, prolonged glucocorticosteroid (GCS) use, and nutritional issues contribute to growth stunting and pubertal delays. Chronic inflammation in JIA flattens growth curves, while steroid treatment impairs growth and causes weight gain. Disruption of the GH/IGF1 axis is known, but data on systemic hormonal resistance in JIA are insufficient. Optimizing JIA treatment, including biological therapies, is expected to improve growth velocity and reduce long-term impacts by better disease control and reduced GCS doses. Thyroid function also influences growth and puberty, but comprehensive studies on thyroid involvement in JIA are lacking. Given the early onset of chronic inflammatory consequences, preventive auxological screening measures are necessary for children with JIA. Early detection of developmental disorders can enhance therapeutic management. This article summarizes information from a cohort study on growth in children with JIA and proposes a diagnostic algorithm for clinical use.

Keywords: Growth impairment; algorithm; children; juvenile idiopathic arthritis.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
ROC curve for BMI (a.) and TPI (b.) in children with JIA (>10 years).
Figure 2
Figure 2
Evaluation of anthropometric indicators (weight, height) and BMI according to JIA onset subtype, SD
Figure 3
Figure 3
Proposed algorithm for the diagnosis and management of growth impairment in JIA.
See this image and copyright information in PMC

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