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Growth hormone treatment in children with rheumatic disease, corticosteroid induced growth retardation, and osteopenia

¹ Dept of Paediatrics, Erasmus MC–Sophia Children’s Hospital, Rotterdam, Netherlands
² Dept of Paediatrics, Leiden University Medical Center, Leiden, Netherlands
³ Dept of Paediatrics, University Hospital Groningen, Groningen, Netherlands
⁴ Dept of Epidemiology & Biostatistics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
⁵ Dept of Paediatric Physiotherapy, Erasmus MC–Sophia Children’s Hospital, Rotterdam, Netherlands

Correspondence to:
Correspondence to:
MrsF K Grote
Dept of Pediatrics J6-S, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, Netherlands; f.k.grote{at}lumc.nl

Background: In children with severe rheumatic disease (RD), treatment with corticosteroids (CS) is frequently needed and growth retardation and osteopenia may develop. A beneficial effect of human growth hormone (hGH) has been reported but mostly in trials without a control group.

Aims: To study the effect of hGH on growth, bone mineral density (BMD), and body composition, taking the disease activity and CS use into account.

Methods: Randomised controlled trial on 17 prepubertal RD patients with growth retardation and/or decreased BMD. The hGH group (n = 10) received treatment with hGH 4 IU/m²/day (0.045 mg/kg/day) during two years. The controls (n = 7) received no GH treatment.

Results: During the two year study period the disease activity, and use of CS and methotrexate (MTX) did not differ between the groups. There was a significant mean increase in height standard deviation score (HSDS) in the hGH group (0.42±0.16 SDS) and a non-significant decrease in the controls (–0.18±0.11 SDS). Change in BMD did not differ significantly between the groups, although the increase in BMD for lumbar spine within the hGH group was significant. Lean body mass improved significantly in the hGH group compared to controls (0.64±0.19 SDS versus –0.20±0.17 SDS), while the decrease in percentage fat was not significant.

Conclusions: There was a significant effect of hGH on growth and lean body mass, but a longer duration of treatment might be necessary to evaluate the effect of hGH on BMD.

Abbreviations: BMD, bone mineral density; CS, corticosteroid; ESR, erythrocyte sedimentation rate; hGH, human growth hormone; HSDS, height standard deviation score; JIA, juvenile idiopathic arthritis; MCTD, mixed connective tissue disease; MTX, methotrexate; RD, rheumatic disease; SDS, standard deviation score; SLE, systemic lupus erythematosus; VAS, visual analogue scale

Keywords: growth disorders; growth hormone; rheumatic diseases; glucocorticoids; body composition

This article has been cited by other articles:

				J N Hoes, J W G Jacobs, M Boers, D Boumpas, F Buttgereit, N Caeyers, E H Choy, M Cutolo, J A P Da Silva, G Esselens, et al. EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases Ann Rheum Dis, December 1, 2007; 66(12): 1560 - 1567. [Abstract] [Full Text] [PDF]

				RCT confirms benefit of hGH for children taking corticosteroids Ann Rheum Dis, January 1, 2007; 66(1): 98 - 98. [Full Text] [PDF]

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