Background Juvenile idiopathic arthritis (JIA) is a chronic autoimmune disease of children and adolescents withprimary joints involvement and various manifestations. Growth disorders in children with JIA are important issue in pediatric rheumathology.
Objectives To estimate the dynamics of growth in children with JIA on the background of treatment with abatacept.
Methods The study included 20 children with JIA.The onset of disease was 4.5±2.8 years (1 year 8 months to 12 year), all children had a high degree of clinical and laboratory activity. 14 patients of all (70%) were with polyarticular form and rheumatoid uveitis, 2 patients (10%) were with oligoarticular form and rheumatoid uveitis, 2 patients were with systemic onset (10%), 1 patient was with polyarticular form, seropositive for RF. All patients received active standard antirheumatic therapy.7 patients (35%)received therapy with glucocorticoids (GC): intra-articular introduction, pulse therapy. All patients were transferred to a genetically engineered biological therapy (GIBT) - abatacept. Growth, the growth rate was estimated taking into account the age and sex of patients, according to the centile tables and was expressed in standard deviation score (SDS). Growth dynamics was assessed by growth SDS before and after connection of the abatacept therapy, growth rate and growth rate SDS during therapy with abataceptin the first year and in subsequent follow-up period.
Results Initially in 19 patients (95%) with JIA growth was within normal limits (growth SDS of 1.01±0,33 (from -1,85 to 1,26)). One patient (5%) had moderate stunting (SDS growth -2,2). During the first year of therapy the growth rate of all patients was 7,83±3,94 cm/year, growth rate SDS was 2,82±5.36. Growth rate of all patients in subsequent follow-up period was 6,09±1,34 cm/year (from 3,89 to 7,59 cm/year), growth rate SDS was - 1,02±1,1,97 (1,46 up 7,13).The growth rate of all patientsduring the first year of therapy was statistically significantly higher thanthe growth rateduring the subsequent follow-up period (p<0.05). The difference between the growth rate SDS in the first year and in the subsequent period was statistically insignificant. Growth all patients duringentire period of observation remained within normal limits, growth SDS was -0,06±0,96 (-1,70 up to 1.38). In 1 patient with previously identified growth delay, growth indicator has bounced back to normal up totwo years of therapy with abatacept (growth SDS -1,70).
Conclusions In patients with JIA, normal growth and high disease activity requiring GIBT, after amplification therapy with abatacept the most intensive growth observed in the first year of therapy (catch-up growth). Abatacept treatment showed an increase of growth in children with juvenileidiopathic arthritis.
Uettwiller F, Perlbarg J, Pinto G. Effect of biologic treatments on growth in children with juvenile idiopathic arthritis. J Rheumatol 2014 Jan;41(1):128-35.
Acknowledgements The staff of rheumatologic department of Pediatric Clinic of 1st Medical state University named after Sechenov
Disclosure of Interest None declared