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No correlation found with BMD, leptin in patients with JIA treated with glucocorticoids
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A cohort of patients with juvenile idiopathic arthritis with low-dose exposure to glucocorticoids had normal body composition, and while patients with low BMD tended to have higher serum leptin levels, a significant association was not seen, according to a recently published report.
Fifty patients (68% girls) with juvenile idiopathic arthritis (JIA) were recruited from the Helsinki University Central Hospital in Finland and matched based on bone age by the Grlich-Pyle method and sex with one to two control children from a Finnish, school-based study of vitamin D and bone health in children in Helsinki. Participants in the vitamin D study were under age 7 years; subsequently, patients under age 7 years were excluded from the present study.
Of the patients, 42% were receiving glucocorticoids (GCs) at the time of the study and 63% had received GCs during the 2 years prior to the study.
Dual-energy -ray absorptiometry (DXA) was used to measure BMD and fat mass, trunk fat mass and lean mass in all participants. Girls over age 8 years and boys over age 10 years were assessed serologically for evidence of puberty.
The Childhood Health Assessment Questionnaire (CHAQ) and other health assessments were administered to all participants and the erythrocyte sedimentation rate (ESR) was measured. In patients with JIA, active disease on medication was assessed by the Wallace method. The Juvenile Arthritis Disease Activity Score for 10 joints (JADAS-10) was calculated with scores ranging from 0 to 40.
Bone age was delayed in 14 patients with JIA, normal in 29 and advanced in seven patients. Between patients and healthy participants, no differences were seen in body composition. Variables related to bone were similar, but patients with JIA were more likely to have a lower BMD in the lumbar spine. Bone mass values did not correlate with disease activity or weight-adjusted GC dose, except with wholebody BMD which correlated negatively with the weight-adjusted GC dose.
No differences were observed between the groups with levels of serum leptin or adiponectin with or without adjusting for fat mass. Adipokines did not correlate with JADAS-10 and were not different between patients who received anti-tumor necrosis factor-alpha inhibitors and patients who did not. No association between leptin and BMD was observed after adjusting for sex, height, puberty status or fat mass in either group. An inverse association was seen between adiponectin and lumbar spine and wholebody BMD in healthy children but only with wholebody BMD in patients with JIA after adjusting for bone age.
A decrease in the ratio of bone mineral content to lean mass was seen in patients with low BMD, and a trend toward active disease was observed within the prior 6 months and the weight-adjusted GC dose tended to be higher in the patients with low BMD. No other associations were observed. – by Shirley Pulawski
Disclosure: The research was funded by a grant from Arthritis Research U.K.
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