Early recombinant human growth hormone treatment in glucocorticoid-treated children with juvenile idiopathic arthritis: A 3-year randomized study

Context: Long-term glucocorticoid therapy adversely affects growth and body composition in children with juvenile idiopathic arthritis (JIA). In previous studies, recombinant human GH (rhGH) halted the progression of these complications without inducing catch-up growth. Objectives: The objective of the study was to evaluate the impact on growth and body composition of rhGH started early after glucocorticoid initiation and to record adverse effects in children with JIA. Design: This is a 3-yr randomized controlled study. Setting: This study was conducted in a teaching hospital. Patients: Thirty children, 12-15 months into glucocorticoid therapy for severe JIA, were enrolled. Intervention: Patients received rhGH (0.46 mg/kg center dot wk) in daily sc injections (n = 15) or no rhGH therapy (n = 15) for 3 yr. Main Outcome Measure: Difference in height SD score (SDS) change between the two groups was assessed. Height velocity, body composition, and oral glucose tolerance were evaluated yearly. Results: Mean height SDS increase was larger with rhGH (+0.37 +/- 1.5 SDS) than without (-0.96 +/- 1.2 SDS) (P = 0.04). Mean height velocity returned to normal within the first year of rhGH treatment and remained normal thereafter. Mean lean mass increase was greater with rhGH treatment (+7.3 +/- 2.9 kg vs. +4.4 +/- 2.8 kg; P = 0.03). Fat mass and bone mineralization were not significantly different in the two groups. Fasting serum insulin increased significantly in rhGH-treated patients (5.2 +/- 16 mIU/liter) compared with untreated controls (+2.3 +/- 5 mIU/liter) (P = 0.04); fasting glycemia was unchanged. Conclusions: rhGH started early in the course of JIA preserved normal growth velocity and height. Although rhGH was well tolerated, carbohydrate metabolism should be monitored closely.