Background Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children.
Delayed onset of puberty and a growth retardation spurt are often reported in patients suffering from JIA. The basis of abnormal puberty in these patients is multifactorial.
Both chronic inflammation and antiinflammatory therapy with glucocorticosteroids may deteriorate linear and pubertal growth.
The aim of our study was to evaluate the linear and pubertal growth of Moroccan children and adolescent with JIA and to identify factors playing role in contributed to growth disorders and delayed puberty.
Methods Thirty three subjects with juvenile idiopathic arthritis (JIA) were included in a cross-sectional study. The diagnosis of JIA was made according to the criteria of the International League of Association of Rheumatology (ILAR). Information on disease activity, quality of life, sex, age, age at diagnosis, duration and medication use were collected by use of a standardized questionnaire. Patients underwent anthropometric assessment (expressed in standard deviations according to the age and of the sex according to the World Health Organization). Body mass index (BMI) was calculated from the ratio of weight/height2 (kg/m2).The pubertal status was determined according to the Tanner criteria (from 1 to 5), thus the evaluation of appearance of the secondary sexual characters was carried out by comparison at the chronological age [2-3], the children were also divided into 3 groups: pre-puberty (stage 1), puberty (stages 2-3) and post-puberty (stage 4-5). Bone mineral density (BMD) assessment by dual energy x-ray absorptiometry of the lumbar spine, and total body. Bone mineral density (in g/cm2) was expressed in Z-scores. In children, low BMD was defined as a Z-score less than -2 and osteoporosis was defined as a Z-score less than -2 with a fracture history.
Results Thirty three children with JIA were included (18 male, 15 female), the median of age of the patients was11 years [6-14]. The prevalence of the underweight (IMC <2DS) was of 27%. The prevalence of the children in prepuberty was of 36.4% and 24% in postpuberty with a median of tanner of 2 [1-3,5]. The prevalence of the children having a delayed puberty was of 27.3%.
There was an association between the delayed puberty and the by corticosteroids (p=0,05). In addition There was no significant association between this poor puberty and the subtype of JIA (p=0.2), its duration (p=0.3) and its activity calculated by the DAS28 (p=0. 8).
A significant association was found between the underweight and the low BMD (p=0.01). There was a positive correlation between the height and the BMD (r=0.48, p=0.005) in the lumbar spine and (r=0.57, p=0.001) for the total body).
Conclusions Our study suggests that linera growth and puberty is retarded in Moroccan patients with JIA, and that corticosteroids may contribute to delayed puberty.
Disclosure of Interest None Declared