Grammatikopoulou Maria G, Gkiouras Konstantinos, Syrmou Vasiliki, Vassilakou Tonia, Simopoulou Theodora, Katsiari Chistina G, Goulis Dimitrios G, Bogdanos Dimitrios P
Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece.
Department of Public Health Policy, School of Public Health, University of West Attica, 196 Alexandras Avenue, GR-11521 Athens, Greece.
Children (Basel). 2023 Jan 23;10(2):203. doi: 10.3390/children10020203.
Juvenile idiopathic arthritis (JIA) represents a chronic, autoimmune, rheumatic musculoskeletal disease with a diagnosis before 16 years of age. Chronic arthritis is a common manifestation in all JIA subtypes. The nature of JIA, in combination to its therapy often results in the development of nutrition-, gastrointestinal (GI)- or metabolic-related issues. The most-common therapy-related nutritional issues involve methotrexate (MTX) and glucocorticosteroids (GCC) adverse events. MTX is a folic acid antagonist, thus supplementation with folic acid in required for improving GI side effects and correcting low serum levels. On the other hand, long-term GCC administration is often associated with hyperglycemia, insulin resistance and growth delay. This relationship is further aggravated when more joints are affected and greater doses of GCC are being administered. Apart from stature, body mass index z-scores are also suboptimal in JIA. Other signs of malnutrition include decreased phase angle and muscle mass, especially among patients with polyarthritis JIA. Evidence also points to the existence of an inverse relationship between disease activity and overweight/obesity. Specific dietary patterns, including the anti-inflammatory diet, might confer improvements in selected JIA outcomes, but the level of available research is yet insufficient to draw safe conclusions. The majority of patients exhibit suboptimal vitamin D status; hence, supplementation is recommended. Collectively, the evidence indicates that, due to the age of onset and the complexity of the disease, along with its pharmacotherapy, children with JIA are prone to the development of several nutritional problems, warranting expert monitoring. Vitamin deficiencies, oral and GI-problems limiting dietary intake, faltering growth, overweight and obesity, physical inactivity, or impaired bone health are among the many nutritional issues in JIA requiring dietitian support.
幼年特发性关节炎（JIA）是一种慢性自身免疫性风湿性肌肉骨骼疾病，诊断年龄在16岁之前。慢性关节炎是所有JIA亚型的常见表现。JIA的性质及其治疗方法常常导致营养、胃肠道（GI）或代谢相关问题的出现。最常见的与治疗相关的营养问题涉及甲氨蝶呤（MTX）和糖皮质激素（GCC）的不良事件。MTX是一种叶酸拮抗剂，因此需要补充叶酸以改善胃肠道副作用并纠正血清水平过低的情况。另一方面，长期使用GCC通常与高血糖、胰岛素抵抗和生长发育迟缓有关。当更多关节受到影响且使用更大剂量的GCC时，这种关系会进一步恶化。除了身高，JIA患者的体重指数z评分也不理想。营养不良的其他迹象包括相角和肌肉量减少，尤其是在多关节型JIA患者中。有证据还表明疾病活动与超重/肥胖之间存在负相关关系。特定的饮食模式，包括抗炎饮食，可能会改善某些JIA的预后，但现有研究水平尚不足以得出可靠结论。大多数患者的维生素D水平不理想；因此，建议进行补充。总体而言，证据表明，由于发病年龄、疾病的复杂性及其药物治疗，JIA患儿容易出现多种营养问题，需要专家进行监测。维生素缺乏、限制饮食摄入的口腔和胃肠道问题、生长发育迟缓、超重和肥胖、身体活动不足或骨骼健康受损等都是JIA中众多需要营养师支持的营养问题。
