Endocrine dysfunction in patients with juvenile idiopathic arthritis.

Abstract

Objectives: To assess the prevalence of endocrine dysfunction in patients with JIA and identify potential contributory factors for growth and sexual development.

Methods: A prospective observational study was conducted between July 2021 to January 2023, recruited 107 children of JIA fulfilling the revised ILAR classification criteria with disease duration > 6 months, attending Rheumatology department in KGMU, India. Demographic, clinical (anthropometric), and serological (including hormonal) evaluations were assessed at baseline. Growth velocity was recorded after one year. Mann-Whitney U test, chi-square test, and Fisher's exact t test were applied during statistical analysis.

Results: 107 JIA patients were enrolled with a M: F ratio of 2.06:1 (72 boys & 35 girls) with ERA being the most frequent subtype (51.4%). Mean age was 13 (± 4) years with a disease duration of 33 (± 24) months. Mean glucocorticoid intake was 2.17 (± 5.41) mg/day at baseline. 20.6% children were stunted, 22.4% were underweight and 25.2% had low BMI. Stunted children were more likely to have early onset (p = 0.015) & high GH level (p = 0.013). Underweight children had longer disease (p = 0.047) and more damage (p = 0.006). Children with weight z < -2 have high GH and low IGFBP3. Low BMI group had high disease activity, damage, and poor quality of life & functional state (p = < 0.01). Delayed puberty was noticed only in 2.8% of children. Girls with low Estradiol level had longer exposure to corticosteroids. Slower growth velocity was observed in 22.4% of children without any identifiable cause.

Conclusion: One third of JIA patients experience growth and pubertal disturbances, primarily due to altered GH-IGF1 axis.