Background: In patients with juvenile idiopathic arthritis (JIA), growth impairment and altered body composition, including disturbed skeletal development, are well-known long-term complications. Data on longitudinal growth in patients with systemic and polyarticular JIA reveal growth impairment in the active phases of the disease. With reduction in disease activity and lower glucocorticoid (GC) doses, some patients experience ‘catch-up’ growth; however, many have only a slight improvement in height standard deviation during puberty or after cessation of GC treatment. The consequence is a final height below the 3rd percentile and below the genetic height potential. Although few studies have specifically addressed body composition in children with JIA, studies on the development of bone mass have described notable deficits in both GC-treated and GC-naïve children. In recent years, the deficits in bone mass have been related, in part, to the deficits in muscle mass, which are prevalent in these patients. Conclusions: The major goal for physicians caring for patients with JIA is optimal disease control while maintaining normal growth. Early recognition of patients who develop prolonged growth disturbances and altered body composition is important as these abnormalities contribute to long-term morbidity and need to be addressed both diagnostically and therapeutically when treating children with JIA.

Simon D, Fernando C, Czernichow P, Prieur AM: Linear growth and final height in patients with systemic juvenile idiopathic arthritis treated with longterm glucocorticoids. J Rheumatol 2002;29:1296–1300.
Kotaniemi A: Growth retardation and bone loss as determinations of axial osteopenia in juvenile chronic arthritis. Scand J Rheumatol 1997;26:14–18.
Still GF: On a form of chronic joint disease in children. Am J Dis Child 1978;132:195–200 [reprinted from Medico-Chirurgical Transactions, 1897, vol 80].
Ansell BM, Bywaters EG: Growth in Still’s disease. Ann Rheum Dis 1956;15:295–319.
Polito C, Strano CG, Olivieri AN, Alessio M, Iammarrone CS, Todisco N, Papale MR: Growth retardation in non-steroid treated juvenile rheumatoid arthritis. Scand J Rheumatol 1997;26:99–103.
Liem JJ, Rosenberg AM: Growth pattern in juvenile rheumatoid arthritis. Clin Exp Rheumatol 2003;21:663–668.
Zak M, Müller J, Karup Pedersen F: Final height, armspan, subischial leg length and body proportions in juvenile chronic arthritis. A long-term follow-up study. Horm Res 1999;52:80–85.
Bechtold S, Ripperger P, Häfner R, Said E, Schwarz HP: Growth hormone improves height in patients with juvenile idiopathic arthritis: 4-year data of a controlled study. J Pediatr 2003;143:512–519.
Bechtold S, Ripperger P, Dalla Pozza R, Bonfig W, Häfner R, Michels H, Schwarz HP: Growth hormone increases final height in patients with juvenile idiopathic arthritis: data from a randomized controlled study. J Clin Endocrinol Metab 2007;92:3013–3018.
Tynjälä P, Lahdenne P, Vähäsalo P, Kautiainen H, Honkanen V: Impact of anti-TNF treatment on growth in severe juvenile idiopathic arthritis. Ann Rheum Dis 2006;65:1044–1049.
Simon D, Prieur AM, Quartier P, Charles Ruiz J, Czernichow P: Early recombinant human growth hormone treatment in glucocorticoid-treated children with juvenile idiopathic arthritis: a 3-year randomized study. J Clin Endocrinol Metab 2007;92:2567–2573.
Rall LC, Roubenoff R: Rheumatoid cachexia: metabolic abnormalities, mechanisms and interventions. Rheumatology (Oxford) 2004;43:1219–1223.
Reilly JP: Assessment of body composition in infants and children. Nutrition 1998;14:821–825.
Roth J, Bechtold S, Borte G, Dressler F, Girschick H, Borte M: Osteoporosis in juvenile idiopathic arthritis – a practical approach to diagnosis and therapy. Eur J Pediatr 2007;166:775–784.
Herzog W, Longino D, Clark A: The role of muscles in joint adaptation and degeneration. Langenbecks Arch Surg 2003;388:305–315.
Bechtold S, Ripperger P, Bonfig W, Pozza RD, Haefner R, Schwarz HP: Growth hormone changes bone geometry and body composition in patients with juvenile idiopathic arthritis requiring glucocorticoid treatment: a controlled study using peripheral quantitative computed tomography. J Clin Endocrinol Metab 2005;90:3168–3173.
Kotaniemi A, Savolainen A, Kautiainen H, Kroeger H: Estimation of central osteopenia in children with chronic polyarthritis treated with glucocorticoids. Pediatrics 1993;91:1127–1130.
Falcini F, Trapani S, Civinini R, Capone A, Ermini M, Bartolozzi G: The primary role of steroids on the osteoporosis in juvenile rheumatoid arthritis patients evaluated by dual energy x-ray absorptiometry. J Endocrinol Invest 1996;9:165–169.
Knops N, Wulffraat N, Lodder S, Houwen R, de Meer K: Resting energy expenditure and nutritional status in children with juvenile rheumatoid arthritis. J Rheumatol 1999;26:2039–2043.
Pepmueller PH, Cassidy JT, Allen SH, Hillman LS: Bone mineralization and bone mineral metabolism in children with juvenile rheumatoid arthritis. Arthritis Rheum 1996;39:746–757.
Kotaniemi A, Savolainen A, Kroger H, Kautiainen H, Isomaki H: Weight-bearing physical activity, calcium intake, systemic glucocorticoids, chronic inflammation and body constitution as determinants of lumbar and femoral bone mineral in juvenile chronic arthritis. Scand J Rheumatol 1999;28:19–26.
Henderson CJ, Cawkwell GD, Specker BL, Sierra RI, Wilmott RW, Campaigne BN, Lovell DJ: Predictors of total body bone mineral density in non-corticosteroid treated prepubertal children with juvenile rheumatoid arthritis. Arthritis Rheum 1997;40:1967–1975.
Henderson CJ, Specker BL, Sierra RI, Campaigne BN, Lovell DJ: Total body bone mineral content in non-corticosteroid treated postpubertal females with juvenile rheumatoid arthritis. Arthritis Rheum 2000;43:531–540.
Bechtold S, Ripperger P, Dalla Pozza R, Schmidt H, Hafner R, Schwarz HP: Musculoskeletal and functional muscle-bone analysis in children with rheumatic disease using peripheral quantitative computed tomography. Osteoporosis Int 2005;16:757–763.
Roth J, Palm C, Scheunemann I, Ranke MB, Schweizer R, Dannecker GE: Musculoskeletal abnormalities of the forearm in patients with juvenile idiopathic arthritis relate mainly to bone geometry. Arthritis Rheum 2004;50:1277–1285.
Roth J, Linge M, Tzaribachev N, Schweizer R, Kuemmerle-Deschner J: Muskuloskeletal system in juvenile arthritis – a 4-year longitudinal study. Rheumatology (Oxford) 2007;46:1180–1184.
Burnham JM, Shults J, Dubner SE, Sembhi H, Zemel BS, Leonard MB: Bone density, structure, and strength in juvenile idiopathic arthritis: importance of disease severity and muscle deficits. Arthritis Rheum 2008;58:2518–2527.
Lien G, Selvaag AM, Flatø B, Haugen M, Vinje O, Sørskaar D, Dale K, Egeland T, Førre Ø: A two-year prospective controlled study of bone mass and bone turnover in children with early juvenile idiopathic arthritis. Arthritis Rheum 2005;52:833–840.
Zak M, Hassager C, Lovell DJ, Nielsen S, Henderson CJ, Pedersen FK: Assessment of bone mineral density in adults with a history of juvenile chronic arthritis: a cross-sectional long-term followup study. Arthritis Rheum 1999;42:790–798.
Lien G, Flatø B, Haugen M, Vinje O, Sørskaar D, Dale K, Johnston V, Egeland T, Førre Ø: Frequency of osteopenia in adolescents with early-onset juvenile idiopathic arthritis: a long-term outcome study of one hundred five patients. Arthritis Rheum 2003;48:2214–2223.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.