Simon Dominique
Service d'Endocrinologie Pédiatrique, Hôpital Robert Debré, Paris, France.
Horm Res. 2007;68 Suppl 5:122-5. doi: 10.1159/000110605. Epub 2007 Dec 10.
Inflammation and glucocorticoid therapy are major factors in the growth retardation seen in children with severe forms of juvenile idiopathic arthritis (JIA). It has been recently shown that tumor necrosis factor (TNF)-alpha antagonist therapy can improve growth velocity in JIA patients; however, the recombinant human soluble TNF-alpha receptor fusion protein etanercept has had limited efficacy in systemic forms of JIA. For several years, growth hormone (GH) has been used to treat growth retardation in patients with JIA receiving glucocorticoids. GH treatment can normalize growth velocity and prevent the severe loss of height; however, catch-up growth markedly varies with the severity of the inflammatory state and the steroid doses used during GH treatment. Recently, early institution of GH treatment has been shown to maintain normal growth in children with JIA.
These promising results show the need for careful monitoring of growth in children with JIA, the utility of GH therapy before the onset of severe growth delay and the potential for preservation of long-term growth during disease progression.
炎症和糖皮质激素治疗是重度幼年特发性关节炎（JIA）患儿生长迟缓的主要因素。最近有研究表明，肿瘤坏死因子（TNF）-α拮抗剂治疗可提高JIA患者的生长速度；然而，重组人可溶性TNF-α受体融合蛋白依那西普在系统性JIA中的疗效有限。数年来，生长激素（GH）一直被用于治疗接受糖皮质激素治疗的JIA患者的生长迟缓。GH治疗可使生长速度恢复正常并防止身高严重丢失；然而，追赶生长明显因炎症状态的严重程度以及GH治疗期间使用的类固醇剂量而异。最近有研究表明，早期开始GH治疗可使JIA患儿维持正常生长。
这些令人鼓舞的结果表明，有必要对JIA患儿的生长情况进行仔细监测，在严重生长延迟发生之前使用GH治疗的效用，以及在疾病进展过程中保留长期生长的潜力。
