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McErlane F, Carrasco R, Kearsley-Fleet L, Baildam EM, Wedderburn LR, Foster HE, Ioannou Y, Chieng SEA, Davidson JE, Thomson W, Hyrich KL. Growth patterns in early juvenile idiopathic arthritis: Results from the Childhood Arthritis Prospective Study (CAPS). Semin Arthritis Rheum 2017; 48:53-60. [PMID: 29217290 PMCID: PMC6089842 DOI: 10.1016/j.semarthrit.2017.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/17/2017] [Accepted: 11/03/2017] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To investigate early vertical growth patterns and factors associated with poor growth in a modern inception cohort of UK children with juvenile idiopathic arthritis (JIA) using data from the Childhood Arthritis Prospective Study (CAPS). METHODS A study period of 3 years was chosen. Children included in this analysis had a physician diagnosis of JIA and had height measurements available at both baseline and at 3-years of follow-up. Height is presented as z-scores calculated using World Health Organisation growth standards for age and gender. Growth over the 3-year period was assessed using change in z-score and height velocity. Univariable and multivariable linear regressions were used to identify factors associated with height z-score at baseline and change of height z-score at 3 years. RESULTS 568 patients were included; 65% female, median baseline age 7.4 years [interquartile range (IQR) 3.6, 11.2], median symptom duration at presentation 5.5 months [IQR 3.1, 11.6]. Height z-score decreased significantly from baseline to 3 years (p ≤ 0.0001); baseline median height z-score was -0.02 (IQR -0.71, 0.61), decreasing to -0.47 (IQR -1.12, 0.24) at 3 years. Growth restriction, defined as change of height z-score ≤-0.5, was observed in 39% of patients. At 3 years, higher baseline height z-score was the strongest predictor for a negative change in height z-score [-0.3 per unit of baseline height z-score (95% CI: -0.36, -0.24), p < 0.0001]. CONCLUSIONS Although overall height at 3 years after initial presentation to rheumatology is within the population norm, as a cohort, children with JIA experience a reduction of growth in height over the first 3 years of disease. Late presentation to paediatric rheumatology services is associated with lower height at presentation. However, patients with the lowest height z scores at presentation were also the most likely to see an improvement at 3 years. The impact of JIA on growth patterns is important to children and families and this study provides useful new data to support informed clinical care.
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Affiliation(s)
- Flora McErlane
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle Hospitals NHS Trust, Newcastle upon Tyne, UK; Rheumatology, Institute Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Roberto Carrasco
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Division of Musculoskeletal & Dermatological Sciences. Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Lianne Kearsley-Fleet
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Division of Musculoskeletal & Dermatological Sciences. Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Eileen M Baildam
- Paediatric Rheumatology, Alder Hey Children's Hospital, Liverpool, UK
| | - Lucy R Wedderburn
- Arthritis Research UK Centre for Adolescent Rheumatology, Infection, Inflammation and Rheumatology Section, UCL GOS Institute of Child Health, London, UK
| | - Helen E Foster
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle Hospitals NHS Trust, Newcastle upon Tyne, UK; Rheumatology, Institute Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Yiannis Ioannou
- Arthritis Research UK Centre for Adolescent Rheumatology, Division of Medicine, University College London (UCL), London, UK
| | - S E Alice Chieng
- Rheumatology, Royal Manchester Children's Hospital, Manchester, UK
| | - Joyce E Davidson
- Paediatric Rheumatology, Royal Hospital for Children, Glasgow, UK; Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Wendy Thomson
- Arthritis Research UK Center for Genetics and Genomics, Centre for Musculoskeletal Research, Division of Musculoskeletal & Dermatological Sciences. Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Kimme L Hyrich
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Division of Musculoskeletal & Dermatological Sciences. Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
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Makay B, Gücenmez ÖA, Ünsal E. Inactive Disease in Enthesitis-related Arthritis: Association of Increased Body Mass Index. J Rheumatol 2016; 43:937-43. [PMID: 26980582 DOI: 10.3899/jrheum.151208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Patients with enthesitis-related arthritis (ERA) were less likely to achieve and sustain inactive disease than children with other subtypes of juvenile idiopathic arthritis. The aim of this study was to evaluate the effect of increased body mass index (BMI) on clinical features of the disease and to investigate whether being overweight or obese limits the possibility of achieving clinically inactive disease in patients with ERA. METHODS The hospital charts of 72 patients with ERA were reviewed. Demographic and clinical findings were recorded. Patients were divided into 2 groups according to whether they had "healthy weight" (BMI < 85th percentile) or "increased weight" (BMI ≥ 85th percentile) at baseline. The primary outcome of this study was to achieve inactive disease at 1 year after the initiation of therapy. The inactive disease criterion of Wallace, et al was used to define inactive disease status. RESULTS Twenty patients had increased BMI. The frequency of tarsitis and ankle involvement was higher in patients with increased weight. Thirty-seven patients were inactive at the end of 1 year. In univariate analyses, male sex, increased BMI, ankle involvement, and tarsitis were found to be associated with failure to achieve inactive disease. Multivariate backward stepwise regression analyses revealed that failure to achieve clinically inactive disease was associated with increased BMI and ankle involvement. CONCLUSION Being overweight or obese was associated with failure to achieve inactive disease in patients with ERA. Because body weight is a modifiable factor, individualized interventions may have clinical implications for better therapeutic outcome.
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Affiliation(s)
- Balahan Makay
- From the Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Hospital, Balçova, Turkey.B. Makay, MD, Associate Professor, Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Hospital; Ö.A. Gücenmez, MD, Specialist, Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Hospital; E. Ünsal, MD, Professor, Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Hospital.
| | - Özge Altuğ Gücenmez
- From the Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Hospital, Balçova, Turkey.B. Makay, MD, Associate Professor, Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Hospital; Ö.A. Gücenmez, MD, Specialist, Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Hospital; E. Ünsal, MD, Professor, Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Hospital
| | - Erbil Ünsal
- From the Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Hospital, Balçova, Turkey.B. Makay, MD, Associate Professor, Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Hospital; Ö.A. Gücenmez, MD, Specialist, Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Hospital; E. Ünsal, MD, Professor, Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Hospital
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Pelajo CF, Lopez-Benitez JM, Miller LC. Obesity and disease activity in juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2012; 10:3. [PMID: 22240096 PMCID: PMC3283518 DOI: 10.1186/1546-0096-10-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 01/12/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Children with physical disabilities may have an increased risk for obesity and obesity might be a risk factor for inflammatory arthritis. The aims of this study were: to determine the prevalence of obesity in children and adolescents with juvenile idiopathic arthritis (JIA), and to examine the association between obesity and disease activity in this population. FINDINGS A cross-sectional analysis of all patients with JIA attending a pediatric rheumatology clinic, between October 2009 and September 2010, was performed. A linear regression model was used to explore the association between obesity and disease activity in patients with JIA. A total of 154 subjects were included in the analysis; median age was 10.6 years, 61% were female, and 88% were white. Obesity was found in 18%, 12% were overweight, and 3% were underweight. There was no association between obesity and JADAS-27 (Juvenile Arthritis Disease Activity Score 27), physician's assessment of disease activity, parent's assessment of child's well-being, erythrocyte sedimentation rate, number of active joints, or C-reactive protein (p-value range 0.10 to 0.95). CONCLUSIONS Although 18% of patients with JIA were obese, we did not find an association between obesity and disease activity. As obesity confers an additional health risk in children with arthritis, addressing this co-morbidity should be a health priority in patients with JIA. Future studies are necessary to further explore potential associations between obesity, development of JIA, and disease activity.
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Affiliation(s)
- Christina F Pelajo
- Department of Pediatric Rheumatology, Floating Hospital for Children at Tufts Medical Center, 800 Washington St, Box #190 Boston, MA 02111.
| | - Jorge M Lopez-Benitez
- Department of Pediatric Rheumatology, Floating Hospital for Children at Tufts Medical Center, 800 Washington St, Box #190 Boston, MA 02111
| | - Laurie C Miller
- Department of Pediatric Rheumatology, Floating Hospital for Children at Tufts Medical Center, 800 Washington St, Box #190 Boston, MA 02111
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