Vojvodich Paola Fernandez, Hansen Jes B, Andersson Ulf, Sävendahl Lars, Hagelberg Stefan
Pediatric Endocrinology Unit, Department of Woman and Child Health, Karolinska University Hospital, Stockholm, Sweden.
J Rheumatol. 2007 Dec;34(12):2481-5. Epub 2007 Nov 15.
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.
Out of 52 children treated with etanercept, we studied 20 prepubertal and 11 early/midpubertal patients adherent to treatment for at least 1 year. We collected data on growth and glucocorticoid medication and calculated each patient's height standard deviation score (SDS) in relation to the mid-parental height, the change of this value (DeltahSDS) from 1 to 0 and 0 to 1 year of treatment, and the change between the DeltahSDS values to assess growth improvement.
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 DeltahSDS before etanercept was 0.3 +/- 0.1 in prepubertal and 0.2 +/- 0.2 in pubertal patients. Over the first year with etanercept, DeltahSDS 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 (DeltahSDS) in response to etanercept treatment when analyzed individually. The need for intraarticular glucocorticoid injections was negatively correlated to the improved growth (p = 0.001).
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.
抗肿瘤坏死因子（TNF）治疗已知可降低幼年特发性关节炎（JIA）的疾病活动度，但其对与青春期相关的纵向生长的影响尚不清楚。我们研究了接受依那西普治疗的青春期前和青春期JIA患者的纵向生长情况。
在52例接受依那西普治疗的儿童中，我们研究了20例青春期前和11例青春期早期/中期且坚持治疗至少1年的患者。我们收集了生长和糖皮质激素用药的数据，并计算了每位患者相对于父母平均身高的身高标准差评分（SDS）、该值在治疗1年至0年以及0年至1年的变化（ΔhSDS），以及ΔhSDS值之间的变化以评估生长改善情况。
在青春期前组，治疗1年、0年和 +1年时相对身高SDS（均值±均值标准误）分别为1.8±0.2、2.1±0.3和1.9±0.3，在青春期组分别为1.1±0.4、1.3±0.3和1.1±0.3。依那西普治疗前，青春期前患者的ΔhSDS为0.3±0.1，青春期患者为0.2±0.2。在使用依那西普的第一年，青春期前患者的ΔhSDS为 +0.2±0.1（与依那西普治疗前相比，p = 0.001；配对t检验），青春期患者为 +0.2±0.1（p = 0.071）。然而，单独分析时，大多数青春期前（17/20）和青春期（8/11）患者对依那西普治疗有生长改善（ΔhSDS）。关节内注射糖皮质激素的需求与生长改善呈负相关（p = 0.001）。
依那西普抑制TNF可改善大多数JIA患者生长。我们的数据表明，依那西普改善生长与青春期生长突增无关。
