Bechtold S, Roth J
Division of Pediatric Endocrinology, University Children's Hospital, Munich, Germany.
Horm Res. 2009 Nov;72 Suppl 1:13-9. doi: 10.1159/000229758. Epub 2009 Nov 27.
In patients with juvenile idiopathic arthritis (JIA), growth impairment and altered body composition, including disturbed skeletal development, are well-known long-term complications. Data on longitudinal growth in patients with systemic and polyarticular JIA reveal growth impairment in the active phases of the disease. With reduction in disease activity and lower glucocorticoid (GC) doses, some patients experience 'catch-up' growth; however, many have only a slight improvement in height standard deviation during puberty or after cessation of GC treatment. The consequence is a final height below the 3rd percentile and below the genetic height potential. Although few studies have specifically addressed body composition in children with JIA, studies on the development of bone mass have described notable deficits in both GC-treated and GC-naïve children. In recent years, the deficits in bone mass have been related, in part, to the deficits in muscle mass, which are prevalent in these patients.
The major goal for physicians caring for patients with JIA is optimal disease control while maintaining normal growth. Early recognition of patients who develop prolonged growth disturbances and altered body composition is important as these abnormalities contribute to long-term morbidity and need to be addressed both diagnostically and therapeutically when treating children with JIA.
在幼年特发性关节炎（JIA）患者中，生长发育受损和身体成分改变，包括骨骼发育紊乱，是众所周知的长期并发症。关于全身型和多关节型JIA患者纵向生长的数据显示，在疾病的活动期会出现生长发育受损。随着疾病活动度降低和糖皮质激素（GC）剂量减少，一些患者会出现“追赶”生长；然而，许多患者在青春期或停止GC治疗后身高标准差仅有轻微改善。结果是最终身高低于第3百分位数且低于遗传身高潜力。尽管很少有研究专门针对JIA儿童的身体成分，但关于骨量发育的研究描述了接受GC治疗和未接受GC治疗的儿童均存在明显的骨量不足。近年来，骨量不足部分与这些患者中普遍存在的肌肉量不足有关。
照顾JIA患者的医生的主要目标是在维持正常生长的同时实现最佳疾病控制。早期识别出现长期生长障碍和身体成分改变的患者很重要，因为这些异常会导致长期发病，在治疗JIA儿童时需要从诊断和治疗两方面加以解决。
