Predictors of total body bone mineral density in non‐corticosteroid‐treated prepubertal children with juvenile rheumatoid arthritis

Cj, Henderson; Gd, Cawkwell; Specker, Bonny; Ri, Sierra; Rw, Wilmott; Bn, Campaigne; Lovell, DJ

doi:10.1002/art.1780401108

Cited by 103 publications

(62 citation statements)

References 32 publications

(15 reference statements)

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“…No patients with delayed puberty were included in our study. Two other DXA studies (21,22) distinguished between pre-and postpubertal girls with JIA (patients taking corticosteroids were excluded). Among the prepubertal girls, nearly 30% had low total-body BMC, especially those with more active and polyarticular disease.…”

Section: Discussionmentioning

confidence: 99%

Musculoskeletal abnormalities of the forearm in patients with juvenile idiopathic arthritis relate mainly to bone geometry

Roth¹,

Palm²,

Scheunemann³

et al. 2004

Arthritis & Rheumatism

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Objective. Alterations of the skeletal system, including reduced bone mineral density, increased frequency of fractures, and changes in markers of bone metabolism, have been described in juvenile idiopathic arthritis (JIA), but measurement of volumetric bone density and bone geometry is not possible with the techniques used in most studies. This study was undertaken to obtain a more detailed understanding of the musculoskeletal system in JIA by analyzing bone density, bone geometry, and muscle force as the most important factor in bone development.Methods. The technique of peripheral quantitative computed tomography was used in a cross-sectional study of 57 children with the oligoarticular, polyarticular, or systemic form of JIA. Density of trabecular and cortical bone as well as geometric parameters of bone and muscle were measured at the forearm.Results. Children in all subgroups had significantly reduced muscle cross-sectional area, which was strongly correlated with muscle force and abnormalities in geometric parameters of bone, including a significant reduction in cortical thickness. Trabecular density was affected only in the polyarticular JIA group, and cortical density was normal in all subgroups.Conclusion. Our results suggest that an important problem in JIA is the lack of muscle mass and force, together with abnormal bone geometry. The thinned bony cortices might predispose to fractures even though cortical bone density itself is normal. These results might have implications with regard to therapeutic approaches to preserve musculoskeletal integrity in JIA.

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Section: Discussionmentioning

confidence: 99%

Musculoskeletal abnormalities of the forearm in patients with juvenile idiopathic arthritis relate mainly to bone geometry

Roth¹,

Palm²,

Scheunemann³

et al. 2004

Arthritis & Rheumatism

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“…Juvenile rheumatoid arthritis (JRA) is the most common rheumatic disease of childhood [1][2][3][4] and can be associated with uveitis, bone loss, reduced quality of life, and increased mortality [1,[5][6][7][8]. Biologic agents provide a targeted approach to the treatment of JRA, aimed at preventing cytokine-mediated inflammation.…”

Section: Introductionmentioning

confidence: 99%

Anakinra in the treatment of polyarticular-course juvenile rheumatoid arthritis: safety and preliminary efficacy results of a randomized multicenter study

et al. 2008

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This study assessed the safety and preliminary efficacy of the interleukin-1 receptor antagonist anakinra in patients with polyarticular-course juvenile rheumatoid arthritis (JRA). Eighty-six patients entered a 12-week open-label run-in phase (1 mg/kg anakinra daily, ≤100 mg/day). Fifty responders were randomized to anakinra or placebo in a 16-week blinded phase, followed by a 12-month open-label extension (N=44). Due to low enrollment, the primary endpoint was changed from efficacy to safety. The incidence and nature of adverse events were similar across all study phases, with the exception of injection site reactions, which were mild to moderate and decreased with time. Anakinra produced a nonsignificant (P=0.11) reduction in disease flares compared with placebo. When normalized to 1 mg/kg dose, anakinra plasma concentrations were similar to values in adult patients with rheumatoid arthritis. These results indicate that anakinra 1 mg/kg once daily (≤100 mg/day) is safe and well tolerated in patients with JRA.

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“…The development of peak bone mass is the result of interactions between nutritional factors including calcium intake, environmental exposures, physical activity, and medications (7,8). Of particular concern with regard to children with chronic rheumatic diseases are the detrimental effects of chronic inflammation and corticosteroid use (9)(10)(11)(12)(13). These concerns are particularly important in juvenile SLE, since these patients tend to have severe chronic inflammation and frequently receive prolonged courses of high-dose corticosteroid therapy.…”

mentioning

confidence: 99%

Prevalence and etiology of low bone mineral density in juvenile systemic lupus erythematosus

Compeyrot-Lacassagne¹,

Tyrrell²,

Atenafu³

et al. 2007

Arthritis & Rheumatism

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Objective. Studies of adults with systemic lupus erythematosus (SLE) have frequently demonstrated the presence of decreased bone mineral density (BMD).However, there have been few investigations in pediatric patients to date. This study was undertaken to determine the prevalence of low BMD in patients with juvenile SLE and to identify associated risk factors.Methods. We studied 64 consecutive patients with juvenile SLE in whom routine dual x-ray absorptiometry (DXA) scanning was performed. Lumbar spine osteopenia was defined as a BMD Z score of <؊1 and >؊2.5, and osteoporosis as a BMD Z score of <؊2.5. Decreased hip BMD was defined as a value of <80%. Data on disease activity, quality of life, disease-related damage, sex, ethnicity, body mass index, age at diagnosis, age at DXA, medication use and duration, clinical features, and puberty status were collected at the time of DXA.Results. Lumbar spine osteopenia was seen in 24 patients (37.5%) and osteoporosis in 13 (20.3%). Decreased hip BMD was present in 12 patients (18.8%). By univariate analysis, osteopenia was significantly correlated with age, disease duration, duration of corticosteroid use, cumulative corticosteroid dose, azathioprine use, cyclophosphamide use, lupus nephritis, and damage. Two additional variables, mycophenolate mofetil use and class III-IV nephritis, were associated with osteoporosis. Abnormal hip BMD was associated with disease duration, duration of corticosteroid use, and cumulative corticosteroid dose. By multivariate analysis, only disease duration remained in the model for osteoporosis and abnormal hip BMD, while cumulative corticosteroid dose was the variable associated with osteopenia.Conclusion. These results indicate that osteopenia and osteoporosis are common in juvenile SLE and are associated more closely with increased disease duration than with cumulative corticosteroid dose.

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Predictors of total body bone mineral density in non‐corticosteroid‐treated prepubertal children with juvenile rheumatoid arthritis

Cited by 103 publications

References 32 publications

Musculoskeletal abnormalities of the forearm in patients with juvenile idiopathic arthritis relate mainly to bone geometry

Musculoskeletal abnormalities of the forearm in patients with juvenile idiopathic arthritis relate mainly to bone geometry

Anakinra in the treatment of polyarticular-course juvenile rheumatoid arthritis: safety and preliminary efficacy results of a randomized multicenter study

Prevalence and etiology of low bone mineral density in juvenile systemic lupus erythematosus

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