Young adults with juvenile arthritis in remission attain normal peak bone mass at the lumbar spine and forearm

Haugen, Margaretha; Lien, Gunhild; Flatø, Berit; Kvammen, Janne Anita; Vinje, Odd; Sørskaar, Dag; Førre, Ø

doi:10.1002/1529-0131(200007)43:7<1504::aid-anr13>3.0.co;2-0

Cited by 52 publications

(22 citation statements)

References 17 publications

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“…This is in good agreement with several cross-sectional and longitudinal studies demonstrating substantial effects of GCs on muscle atrophy and body composition in patients with medical illnesses such as Crohn’s disease, multiple sclerosis, systemic lupus erythematosus, glucocorticoid-sensitive nephrotic syndrome and post-renal transplantation [18-23]. The significant positive correlation between the activity of the disease and GC use could be explained by the necessity of GC therapy in patients with severe course of disease.…”

Section: Discussionsupporting

confidence: 89%

The association between lean mass and bone mineral content in the high disease activity group of adult patients with juvenile idiopathic arthritis

Marešová

Jarošová

Pavelka

et al. 2014

BMC Musculoskelet Disord

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BackgroundThe study is aimed to evaluate body composition and bone status in adolescent and adult patients with active juvenile idiopathic arthritis (JIA) untreated with tumor necrosis factor alpha inhibitors.MethodsAdult patients (12 male and 19 female) with active JIA and 84 healthy age- and gender- matched controls were enrolled into the study. Body composition (tissue mass in grams, lean mass, fat mass and bone mineral content as a fraction of tissue mass) and areal bone mineral density parameters (aBMD) at the lumbar spine, proximal femur, femoral neck, distal radius and total body were assessed using dual energy x-ray absorptiometry (DXA), and correlated with clinical characteristics of the disease and physical performance tests. Disease activity was assessed using high-sensitivity C-reactive protein (hsCRP) and disease activity score 28 (DAS 28). Differences between the groups were tested by t-test, and One-way ANOVA. Correlations were assessed using the Pearson correlation coefficients and multiple linear regression analysis. Significances were counted at the 0.05 level.ResultsIn patients with clinically active JIA (DAS 28, 6.36 ± 0.64, hsCRP, 18.36 ± 16.95 mg/l), aBMD at all measured sites, bone mineral content (BMC) and lean mass were reduced, and fat mass was increased as compared with healthy controls. Significant negative correlations were observed between BMC and disease duration, use of glucocorticoids (GCs), and fat mass, respectively. A positive correlation was found between BMC and lean mass, and between the body fat fraction and the use of GCs. Using multiple linear regression analysis, lean mass was the only significant predictor of BMC of total body both in men and women, and of BMC of legs (only in men). Lean mass was also the only predicting factor of total proximal femur BMD and femoral neck BMD. No significant correlations have been determined among the body composition parameters and DAS 28 or hsCRP endpoints.ConclusionsIn adult patients with long-term active JIA, lean mass was the main determining factor of total body and leg BMC, and total proximal femur and femoral neck aBMD.

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Section: Discussionsupporting

confidence: 89%

The association between lean mass and bone mineral content in the high disease activity group of adult patients with juvenile idiopathic arthritis

Marešová

Jarošová

Pavelka

et al. 2014

BMC Musculoskelet Disord

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“…Furthermore, 20% of the patients in that study were in remission and 43% had been on glucocorticoid therapy. Haugen (mean age 25 years) in remission of JIA may attain the same BMD as healthy subjects, while those with active disease are in danger of developing osteopaenia and osteoporosis (10). In their cross-sectional study both men and women with persistent JIA had significantly lower BMD in the femoral neck and lumbar spine than their healthy controls.…”

Section: Discussionsupporting

confidence: 65%

“…According to the above-mentioned studies patients having more persistent JIA gained poorer scores on their BMD and similar proportions of JIA subtypes among patients with active JIA were also noted, which may favour the notion that the disease itself contributes to BMD development (2,10). Moreover, the anti-rheumatic efficacy of the medication in our patients betrayed a less active treatment policy compared with current practice (12).…”

Section: Discussionmentioning

confidence: 96%

“…Lifestyle factors such as low levels of physical activity have been related to BMD values in patients with JIA (2,10,11). Finnish patients with JIA have usually had access to a regular physiotherapy programme until adulthood, but lower levels of physical functioning score in health-related quality of life assessment were met in our male and female patients with active JIA, as reported by Arkela-Kautiainen et al (13).…”

Section: Discussionmentioning

confidence: 99%

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Bone mineral content in young adults with active or inactive juvenile idiopathic arthritis and in controls

Hämäläinen¹,

Arkela-Kautiainen²,

Kautiainen³

et al. 2010

Scandinavian Journal of Rheumatology

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“…Known risk factors for low BMD and fragility fractures in children with JIA include the inflammatory process, 8 nutrition, 9 growth impairment, 10 reduced physical activity, 9 and treatment, especially corticosteroids. 11 12 The risk of osteoporosis can be reduced by ensuring good nutrition, 13 encouraging weight bearing exercise, 14 and supplementation with calcium and vitamin D. 14 In adults, bisphosphonates are an effective treatment for osteoporosis, with studies showing improvements in BMD at the spine and hip and a reduction in fracture risk, 15 but there is much less information about their use in children.…”

mentioning

confidence: 99%

Systematic review of effectiveness of bisphosphonates in treatment of low bone mineral density and fragility fractures in juvenile idiopathic arthritis

Thornton

Ashcroft²,

Mughal³

et al. 2006

Archives of Disease in Childhood

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Aims: To evaluate the currently available evidence for the effectiveness of bisphosphonates in children with low bone mineral density (BMD) and fragility fractures associated with juvenile idiopathic arthritis (JIA), and the safety of bisphosphonates in JIA and other conditions. Methods: Literature databases were searched using a structured search strategy. The effectiveness review included any studies of children with JIA treated with bisphosphonates. The safety review also included studies of osteogenesis imperfecta. Quantitative data analysis was not undertaken because of the heterogeneity of the studies; findings were summarised using tables and narrative synthesis. Results: Ninety four studies were identified. Sixteen studies (78 JIA children) were included in the effectiveness review: one randomised controlled trial, three controlled cohort studies, 11 case series, and one case report. At baseline, children had low BMD below the expected values for age and sex matched children. In all studies, treatment with bisphosphonates increased BMD compared with baseline: the mean percentage increase in spine BMD ranged from 4.5% to 19.1%. Overall, studies were heterogeneous and of variable quality. A total of 59 papers were included in the safety review; treatment durations were up to three years. The most common side effect was a flu-like reaction with intravenous treatment. This occurred during the first infusion and was transient; the symptoms were managed with paracetamol and did not occur during subsequent cycles. Conclusions: Bisphosphonates are a promising treatment for low BMD and fragility fractures in children with JIA. However, the quality of the current evidence is variable and better studies are needed to more clearly assess their role.

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Young adults with juvenile arthritis in remission attain normal peak bone mass at the lumbar spine and forearm

Abstract: Our findings imply that most young adults with JA attain the same BMD as healthy subjects if the disease goes into remission, while young adults with active disease have increased risk for osteopenia and osteoporosis.

Cited by 52 publications

References 17 publications

The association between lean mass and bone mineral content in the high disease activity group of adult patients with juvenile idiopathic arthritis

The association between lean mass and bone mineral content in the high disease activity group of adult patients with juvenile idiopathic arthritis

Bone mineral content in young adults with active or inactive juvenile idiopathic arthritis and in controls

Systematic review of effectiveness of bisphosphonates in treatment of low bone mineral density and fragility fractures in juvenile idiopathic arthritis

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