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Growth patterns in early juvenile idiopathic arthritis: Results from the Childhood Arthritis Prospective Study (CAPS)

Lookup NU author(s): Dr Flora McErlane, Emerita Professor Helen Foster

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

© 2017 The Authors. 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.

Publication metadata

Author(s): McErlane F, Carrasco R, Kearsley-Fleet L, Baildam EM, Wedderburn LR, Foster HE, Ioannou Y, Chieng SEA, Davidson JE, Thomson W, Hyrich KL

Publication type: Article

Publication status: Published

Journal: Seminars in Arthritis and Rheumatism

Year: 2018

Volume: 48

Issue: 1

Pages: 53-60

Print publication date: 01/08/2018

Online publication date: 07/11/2017

Acceptance date: 02/04/2016

Date deposited: 18/12/2017

ISSN (print): 0049-0172

ISSN (electronic): 1532-866X

Publisher: WB Saunders

URL: https://doi.org/10.1016/j.semarthrit.2017.11.002

DOI: 10.1016/j.semarthrit.2017.11.002

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