Lurati A, Cimaz R, Gattinara M, Gerloni V, Teruzzi B, Salmaso A, Fantini F
Ospedale Fornaroli, Unità di Reumatologia, Magenta, Milano.
Reumatismo. 2008 Jul-Sep;60(3):224-9.
Puberty is an essential step in bone mass accrual. Growth failure and impairment of sexual maturation are frequent manifestations of chronic illnesses in the paediatric population, and chronic rheumatologic disorders such as juvenile idiopathic arthritis (JIA) are no exception to this.
The aim of our study was to prospectively evaluate bone density in adolescent females with JIA, and to correlate the results with clinical variables, in particular with age at menarche. Lumbar spine (L2-L4) area bone mineral density (aBMD) (assessed by Dual X-ray Absorbiometry, DXA) was monitored every 6-12 months in a group of 38 girls with JIA. The evaluated bone density accrual during the peripubertal time as well as absolute and relative (Z-score) aBMD in relationship with age at menarche, JIA subset, disease activity (as evaluated by ESR and Hgb), corticosteroid and methotrexate treatment (mean pro kg daily dose, cumulative dose) was assessed. Height, body mass index (BMI), bone mass content (BMC) values were also collected. Volumetric BMD (vBMD) evaluated with a geometric correction formula has been calculated and compared to aBMD.
Patients were divided into two groups: - group I included girls with menarche age within normal limits for Italian standards; - group II included girls with delayed menarche. The BMD values and Z scores in group I were not significantly different to normal population. The BMD values and Z scores in group II were significantly decreased when compared to the normal population (p<0.001). With a multivariate analysis only age at menarche seemed independently related to peripubertal mineralization (p=0.025, r between -0.65 and -0.75). With a binary logistic analysis only disease activity (ESR and Hgb values) seems independently related to a menarche delay (1.24+/-0.4 for each mm/h).
Our data show a critical role for disease activity in determination of a regular pubertal onset and an optimal bone density achievement.
青春期是骨量积累的关键阶段。生长发育迟缓以及性成熟障碍是儿科人群慢性疾病的常见表现，青少年特发性关节炎（JIA）等慢性风湿性疾病也不例外。
本研究旨在对患有JIA的青春期女性的骨密度进行前瞻性评估，并将结果与临床变量相关联，尤其是与初潮年龄相关联。对一组38名患有JIA的女孩每6 - 12个月监测一次腰椎（L2 - L4）区域骨密度（aBMD）（通过双能X线吸收法，即DXA进行评估）。评估青春期前后骨密度的积累情况以及与初潮年龄、JIA亚型、疾病活动度（通过血沉和血红蛋白评估）、皮质类固醇和甲氨蝶呤治疗（平均每日每千克剂量、累积剂量）相关的绝对和相对（Z评分）aBMD。还收集了身高、体重指数（BMI）、骨量含量（BMC）值。已使用几何校正公式计算了体积骨密度（vBMD）并与aBMD进行比较。
患者分为两组：- 第一组包括初潮年龄在意大利标准正常范围内的女孩；- 第二组包括初潮延迟的女孩。第一组的骨密度值和Z评分与正常人群无显著差异。与正常人群相比，第二组的骨密度值和Z评分显著降低（p<0.001）。多因素分析显示，只有初潮年龄似乎与青春期周围矿化独立相关（p = 0.025，r在 - 0.65至 - 0.75之间）。二元逻辑分析显示，只有疾病活动度（血沉和血红蛋白值）似乎与初潮延迟独立相关（每毫米/小时为1.24±0.4）。
我们的数据表明疾病活动度在确定正常青春期开始和实现最佳骨密度方面起着关键作用。
