A longitudinal PRINTO study on growth and puberty in juvenile systemic lupus erythematosus

• Published in: Annals of the rheumatic diseases Vol. 71; no. 4; pp. 511 - 517
• Main Authors: Rygg, Marite, Pistorio, Angela, Ravelli, Angelo, Maghnie, Mohamad, Di Iorgi, Natascia, Bader-Meunier, Brigitte, Da Silva, Carlos, Roldan-Molina, Rosa, Barash, Judith, Dracou, Cristina, Laloum, Sylvie Gandon, Jarosova, Katerina, Deslandre, Chantal Job, Koné-Paut, Isabelle, Garofalo, Franco, Press, Joseph, Sengler, Claudia, Tauber, Tsivia, Martini, Alberto, Ruperto, Nicolino
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.04.2012; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Adolescent; Age; Age of Onset; Anthropometry - methods; Biological and medical sciences; Body Height - physiology; Body Mass Index; Child; Children & youth; Chronic illnesses; Diseases of the osteoarticular system; Drug Administration Schedule; Female; Females; Glucocorticoids - administration & dosage; Glucocorticoids - adverse effects; Growth - physiology; Growth Disorders - etiology; Growth Disorders - physiopathology; Humans; Longitudinal Studies; Lupus; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - drug therapy; Lupus Erythematosus, Systemic - physiopathology; Male; Males; Medical sciences; Mortality; Patients; Physical growth; Prospective Studies; Puberty - physiology; Puberty, Delayed - etiology; Puberty, Delayed - physiopathology; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Sex Factors; Human; Immunopathology; Connective tissue disease; Puberty; Skin disease; Systemic lupus erythematosus; Growth; Systemic disease; Adolescent; Rheumatology; Autoimmune disease
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2011-200106

Objective To obtain longitudinal data on growth/puberty in a large-scale, multi-national prospective cohort of juvenile systemic lupus erythematosus (SLE). Methods Data from 331/557 (59.4%) patients ≤18 years old with juvenile SLE in active phase, with anthropometric data available at four follow-up visits, were studied. Results There was a significant reduction in parent-adjusted height z score with time in females and males (p<0.0001), with a significant gender difference (p<0.0001) and with male height being most affected. Median body mass index z score peaked at 6 months and was still significantly above baseline after 26 months (p<0.01), with no gender difference. Standardised height reduction was inversely related to age at onset. Females with onset age <12 years had a median parent-adjusted height z score of −0.87 with no catch-up growth. At the end of the study, growth failure was seen in 14.7% of the females and 24.5% of the males. Height deflection (less than −0.25/year) was found in 20.7% of the females and 45.5% of the males. Delayed pubertal onset was seen in 15.3% and 24% of the females and males, respectively, and delayed/absent menarche was seen in 21.9%, while 36.1% of the females and 44% of the males had some degree of delayed pubertal development. Growth failure baseline determinants were previous growth failure (OR: 56.6), age at first visit ≤13.4 years (OR: 4.2) and cumulative steroid dose >426 mg/kg (OR: 3.6). Conclusions The children at risk of having a negative effect on height and pubertal development are prepubertal and peripubertal children treated with >400 mg/kg cumulative dose of corticosteroids.