Original articleImprovements in growth parameters in children with juvenile idiopathic arthritis associated with the effect of methotrexate on disease activity
Introduction
Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease. The polyarticular and systemic onset forms are often complicated by growth retardation. Local growth disturbances may be observed in the oligoarticular forms, but height and weight curves are normal. Growth retardation involves many factors, including 1) disease activity, resulting in low concentrations of insulin-like growth factor 1 (IGF1) [1], 2) poor nutritional status, with low protein and calorie intakes, and 3) prolonged corticosteroid therapy [2], [3], [4]. Bone mineral formation is also reduced in JIA, and is correlated with disease activity, whereas bone mineral resorption is normal [5]. Non-steroidal anti-inflammatory drugs (NSAID) can adequately control the disease activity in about one third of JIA patients [6], whereas more aggressive therapy is required in other patients. Methotrexate (MTX) is currently the most commonly used disease-modifying anti-rheumatic drug (DMARD) [6], [7], although new drugs such as etanercept have recently been shown to be effective for the control of polyarticular JIA [8]. MTX has been widely used in all subtypes of JIA since 1980 [9]. The clinical response rate ranges from 52 to 75% [10], [11], [12], [13]. However, MTX seems to be less effective in systemic onset forms [14], [15]. Tolerance is generally good [16], [17], [18], [19].
The aim of this study was to assess growth parameters associated with the response to MTX therapy in pre-pubertal children who had not been treated with steroids.
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Patients
Between November 1st, 1998 and April 30th, 1999, we prospectively studied all consecutive JIA patients treated with MTX in whom growth parameters could be assessed in relationship with disease activity. None of the patients enrolled had been treated with corticosteroids. During this period, 360 children with rheumatic diseases were referred to the Pediatric Rheumatology Clinic at Necker-Enfants Malades Hospital (Paris, France). Among these, 220 children suffered from JIA according to the ILAR
Characteristics of the patients
The main characteristics of the population are summarized in Table 1, Table 2. There were 21 girls and six boys. Twenty-five were Caucasian and two were African. Twenty-two children had extended oligoarticular JIA and five had polyarticular JIA. Six had chronic anterior uveitis. Concentrations of antinuclear antibodies were elevated in 26 of the 27 children. None were positive for rheumatoid factor. Twenty-one patients responded to MTX treatment and six did not.
There was no significant
Discussion
Of the 27 children with extended oligoarticular or polyarticular JIA treated with MTX, 77.8% responded to therapy, as assessed by a reduction in disease activity by more than 50%.
In this retrospective evaluation, we only assessed the efficacy of MTX treatment by counting the total number of active joints. When this study was initiated, the recommended core set of criteria for defining improvement in JIA had not yet been validated in a French population [23]. Our study included a higher
Acknowledgements
We would like to thank Dr. P. Landais for his help choosing the statistical tests.
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