Impact of anti-TNF therapy on growth in severe juvenile idiopathic arthritis

Pirjo Tynjälä ^1*, Pekka Lahdenne ¹, Paula Vähäsalo ², Hannu Kautiainen ³ and Visa Honkanen ¹

¹ Hospital for Children and Adolescents, Helsinki University Central Hospital, Finland
² Department of Pediatrics, Oulu University Central Hospital, Finland
³ Rheumatism Foundation Hospital, Heinola, Finland

^* To whom correspondence should be addressed. E-mail: pirjo.tynjala{at}hus.fi.

Accepted 24 January 2006

Abstract

Objectives: To evaluate the impact of anti-tumor necrosis factor (TNF) therapy on growth and to identify the predictors for the change in growth in severe juvenile idiopathic arthritis (JIA).

Methods: Data from 71 JIA patients (43 on etanercept, 28 on infliximab) were reviewed two years before and two years on the anti-TNF therapy. The patients had polyarticular disease course; 48 polyarthritis, 19 extended oligoarthritis, 2 systemic arthritis and 2 enthesitis related arthritis. At the initiation of the anti-TNF therapy, the mean age was 9.6 years and the mean duration of JIA 5.7 years.

Results: In the patients with delayed growth before anti-TNF therapy (n=53), the growth velocity, measured as the change in height SDS, accelerated +0.45 (95%CI 0.33-0.56, p<0.001) during the anti-TNF therapy. In the patients with normal or accelerated growth before anti-TNF therapy (n=18), the change in growth velocity was +0.05 (95%CI 0.07-0.16, p=0.39). At two years on anti-TNF therapy, the growth velocity between these two groups was alike. No difference was discovered between the patients treated with etanercept or infliximab. A decelerating growth rate prior to the anti-TNF therapy was the strongest predictor for the observed increase in the growth velocity. The change in the inflammatory activity remained a significant predictor of the growth velocity even after the decrease in glucocorticoid doses was taken into account.

Conclusion: In the treatment of polyarticular JIA, the anti-TNF therapy not only suppresses inflammation, but also restores growth velocity.

Keywords: JIA, anti-TNF therapy, etanercept, growth, infliximab

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