Etanercept treatment improves longitudinal growth in prepubertal children with juvenile idiopathic arthritis
Vojvodich, P.Fernandez.; Hansen, J.B.; Andersson, U.; Sävendahl, L.; Hagelberg, S.
Journal of Rheumatology 34(12): 2481-2485
2007
ISSN/ISBN: 0315-162X PMID: 18050366 Document Number: 612517
Objective. Anti-tumor necrosis factor (TNF) therapy is known to decrease disease activity of juvenile idiopathic arthritis (JIA), but its effect on longitudinal growth in relation to puberty is not clear. We studied longitudinal growth in response to etanercept treatment in prepubertal and pubertal patients with JIA.Methods. Out of 52 children treated with etanercept, we studied 20 prepubertal and 11 early/midpubertal patients adherent to treatment for at least I year. We collected data on growth and glucocorticoid medication and calculated each patient's height standard deviation score (SDS) in relation to the midparental height, the change of this value (Delta hSDS) from -1 to 0 and 0 to 1 year of treatment, and the change between the Delta hSDS values to assess growth improvement.Results. In the prepubertal group, the relative height SDS (mean standard error of the mean) was -1.8 +/- 0.2, -2.1 +/- 0.3, and -1.9 +/- 0.3, and in the pubertal group -1.1 +/- 0.4, -1.3 +/- 0.3, and -1.1 +/- 0.3 at -1, 0, and +1 year of treatment, respectively. The Delta hSDS before etanercept was -0.3 +/- 0.1 in prepubertal and -0.2 +/- 0.2 in pubertal patients. Over the first year with etanercept, Delta hSDS was +0.2 +/- 0.1 in prepubertal (p = 0.001 vs before etanercept; paired Student t-test) and +0.2 +/- 0.1 in pubertal patients (p = 0.071). Nevertheless, most prepubertal (17/20) and pubertal (8/11) patients had improved growth (Delta hSDS) in response to etanercept treatment when analyzed individually. The need for intraarticular glucocorticoid injections was negatively correlated to the improved growth (p = 0.001).Conclusion. TNF inhibition with etanercept improved growth in a majority of patients with JIA. Our data demonstrate that growth improvement with etanercept was independent of the pubertal growth spurt.