Eremciuc Rodica, Revenco Ninel, Gheonea Cristian
Pediatric Department, "Nicolae Testemițanu" State University of Medicine and Pharmacy from the Republic of Moldova.
Pediatric Clinic No1, Mother and Child Healthcare Institute from Chișinău, Republic of Moldova.
Curr Health Sci J. 2024 Apr-Jun;50(2):207-214. doi: 10.12865/CHSJ.50.02.05. Epub 2024 Jun 30.
Juvenile Idiopathic Arthritis (JIA) includes a range of inflammatory conditions that exhibit chronic arthritis with various clinical presentations. The disease's heterogeneity leads to different impacts on children's health, both short and long-term. Compromised growth, seen as growth retardation and delayed puberty, is a common complication in children with JIA, severely impacting their quality of life. This impairment is linked to disease duration and activity, with severe cases in systemic and polyarticular subtypes. Literature reports growth retardation incidence from 8% to 41%, but data on pubertal impairment is lacking. Growth in children is influenced by systemic and local mechanisms. Chronic inflammation, prolonged glucocorticosteroid (GCS) use, and nutritional issues contribute to growth stunting and pubertal delays. Chronic inflammation in JIA flattens growth curves, while steroid treatment impairs growth and causes weight gain. Disruption of the GH/IGF1 axis is known, but data on systemic hormonal resistance in JIA are insufficient. Optimizing JIA treatment, including biological therapies, is expected to improve growth velocity and reduce long-term impacts by better disease control and reduced GCS doses. Thyroid function also influences growth and puberty, but comprehensive studies on thyroid involvement in JIA are lacking. Given the early onset of chronic inflammatory consequences, preventive auxological screening measures are necessary for children with JIA. Early detection of developmental disorders can enhance therapeutic management. This article summarizes information from a cohort study on growth in children with JIA and proposes a diagnostic algorithm for clinical use.
幼年特发性关节炎（JIA）包括一系列炎症性疾病，这些疾病表现为具有多种临床表现的慢性关节炎。该疾病的异质性导致对儿童健康产生不同的短期和长期影响。生长发育受损，表现为生长迟缓及青春期延迟，是JIA患儿常见的并发症，严重影响其生活质量。这种损害与疾病持续时间和活动度有关，在全身型和多关节型亚型的严重病例中更为明显。文献报道生长迟缓的发生率为8%至41%，但关于青春期受损的数据尚缺乏。儿童的生长受全身和局部机制的影响。慢性炎症、长期使用糖皮质激素（GCS）以及营养问题导致生长发育迟缓及青春期延迟。JIA中的慢性炎症使生长曲线变平，而类固醇治疗会损害生长并导致体重增加。已知生长激素/胰岛素样生长因子1（GH/IGF1）轴受到破坏，但关于JIA中全身激素抵抗的数据不足。优化JIA治疗，包括生物治疗，有望通过更好地控制疾病和减少GCS剂量来提高生长速度并减少长期影响。甲状腺功能也会影响生长和青春期，但缺乏关于甲状腺在JIA中受累情况的综合研究。鉴于慢性炎症后果出现较早，对JIA患儿进行预防性体格检查筛查措施是必要的。早期发现发育障碍可加强治疗管理。本文总结了一项关于JIA患儿生长情况的队列研究信息，并提出了一种供临床使用的诊断算法。
