Nearly 25% of children with systemic lupus erythematosus develop growth impairment
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Growth impairment was reported in 23.6% of children with systemic lupus erythematosus, with corticosteroid duration and exposure prior to late puberty identified as key risk factors, according to data published in Pediatric Rheumatology.
“Factors that contribute to growth impairment in these patients include prolonged duration of the disease, disease severity, age at disease onset, suboptimal nutrition, and use of medications, especially corticosteroids, which constitute the mainstay of SLE therapy,” Lalita Ponin, MD, of the Faculty of Medicine Ramathibodi Hospital, at Mahidol University, in Bangkok, and colleagues wrote.
“Ethnicity was an additional factor that influenced the achievement of final adult height (FAH) in [childhood SLE (cSLE)] patients in a multi-ethnic study,” they added. “Asian patients usually have more severe disease and thus receive more aggressive treatment. However, data on growth trajectory in Asians during treatment while growing to FAH and their association with the cumulative dose of corticosteroids, which has been reported to affect growth, remain limited.”
To examine growth impairment and its predictors among Asian patients with childhood SLE, Ponin and colleagues conducted a retrospective cohort study of all patients aged younger than 15 years diagnosed with SLE at the Faculty of Medicine Ramathibodi Hospital between 2006 and 2016. The researchers reviewed patients’ baseline characteristics, including height, weight, clinical manifestations, disease activity score and medications, from the time of diagnosis to the achievement of full adult height. Age at menarche in girls, adult voice appearance in boys and parental height were obtained via interview.
Out of a total of 140 patients with childhood SLE who reached full adult height, 34 were excluded from the analysis due to transfer, vertebral compression or, in one case, death, resulting in a study population of 106. The researchers calculated patients’ parent-adjusted full adult height (PaFAH) Z-score as the difference between their full-adult-height Z-score for chronological age and their mid parental height Z-score. The patients were classified into two groups — normal growth, defined as a PaFAH Z-scoreof at least–1.5, and growth impairment, defined as a PaFAH Z-scoreof less than–1.5.
According to the researchers, 23.6% of the study population developed growth impairment, including 52.6% of boys and 17.2% of girls. Predictors of growth impairment were male sex (OR = 7.07; 95% CI, 2.11-23.74), duration of disease prior to menarche in girls and adult voice appearance in boys (OR = 1.26; 95% CI, 1.02-1.56) and a cumulative corticosteroid dose of 230mg/kg or more prior to late puberty (OR = 6.99; 95%CI, 1.63-30.02).
“One-fourth of cSLE patients developed growth impairment whereby boys were more affected than girls,” Ponin and colleagues wrote. “The duration of corticosteroid exposure and the cumulative dose of corticosteroid administration before the late phase of puberty were important factors that affected growth development.
“Although control of cSLE is essential, the complications following treatment should be of concern to physicians,” they added. “Decreasing corticosteroid use and choosing alternative immunosuppressive medications to control the disease may prevent further damage. Given that growth is an essential indicator of children’s well-being, early recognition and prevention of growth impairment are crucial aspects of patient care, particularly in patients with chronic illnesses such as cSLE.”
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