Wachstumsstörungen bei Kindern mit juveniler idiopathischer Arthritis

Bechtold Susanne; Dalla Pozza Robert; Schwarz Hans Peter

doi:10.1055/s-0037-1620079

Arthritis und Rheuma, Table of Contents

Arthritis und Rheuma 2006; 26(06): 381-385
DOI: 10.1055/s-0037-1620079

Kinderrheumatologie

Schattauer GmbH

Wachstumsstörungen bei Kindern mit juveniler idiopathischer Arthritis

Growth disturbance in children with juvenile idiopathic arthritis

Bechtold Susanne

¹Dr. von Haunersches Kinderspital der Ludwig-Maximilians Universität (Direktor: Prof. Dr. D. Reinhardt)

,

Dalla Pozza Robert

¹Dr. von Haunersches Kinderspital der Ludwig-Maximilians Universität (Direktor: Prof. Dr. D. Reinhardt)

,

Schwarz Hans Peter

²Pädiatrische Endokrinologie und Diabetologie (Leitung: Prof. Dr. H. P. Schwarz)

› Author Affiliations

Abstract

Zusammenfassung

Störungen des Wachstums und der Knochenentwicklung sind bei Patienten mit juveniler idiopathischer Arthritis (JIA) wohl bekannt. Bei etwa elf Prozent der Patienten ist mit einer Endgröße unter -2 SD zu rechnen. Querschnittsstudien zeigten eine verminderte Kortikalisfläche neben einer erniedrigten Muskelfläche. Daher ist eine effektive Krankheitskontrolle mit möglichst geringen Glukokortikoiddosen anzustreben. Wachstumshormon stellt eine mögliche Therapieoption bei schweren Wachstumsstörungen dar. In einer kontrollierten Studie über vier Jahre konnten wir zeigen, dass es bei mit Wachstumshormon therapierten Patienten zu einer Größenzunahme von 1,0 SD kam, während die nicht therapierten Patienten 0,7 SD verloren. Unter Wachstumshormon kam es zu einer periostalen Knochenapposition und zu einer Zunahme der Muskulatur, was sich positiv auf die Knochenstabilität auswirken dürfte. Krankheitskontrolle durch ein aggressives Therapiemanagement kann Wachstumsstörungen bei Kindern mit JIA verringern. Wachstumshormon stellt dann eine mögliche zusätzliche Therapieoption dar, wenn weitere Störungen des Längenwachstums und der Knochenentwicklung bestehen.

Summary

Disturbance of growth and bone development are well known in children with juvenile idiopathic arthritis (JIA). About 11% of patients will reach a final height below –2 SD. Cross-sectional studies revealed a low cortical and muscle area. One treatment goal is therefore an effective disease control with glucocorticoids in a dose as low as possible. Growth hormone is a possible treatment option in patients with severe growth retardation. In a controlled study over a period of 4 years, there was an increase in height of 1.0 SD in growth hormone treated patients, whereas control patients lost 0.7 SD. In growth hormone treated patients there was periosteal bone apposition together with an increase in muscle mass, possibly indicative for an increase in bone stability. Disease control through an aggressive treatment regime may reduce growth impairment in children with JIA. Growth hormone might be an additive treatment option, if growth disturbance is still present.

Schlüsselwörter

Kleinwuchs - Osteoporose - Zytokine - Wachstumshormon

Keywords

Short stature - osteoporosis - cytokine - growth hormone

Full Text

References

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