JUVENILE RHEUMATOID-ARTHRITIS - EFFECTS OF DISEASE-ACTIVITY AND RECOMBINANT HUMAN GROWTH-HORMONE ON INSULIN-LIKE GROWTH-FACTOR-1, INSULIN-LIKE GROWTH-FACTOR BINDING-PROTEIN-1 AND BINDING-PROTEIN-3, AND OSTEOCALCIN

Objective. To investigate possible mechanisms of growth impairment in children with juvenile rheumatoid arthritis (JRA). Methods. Eighteen p repubertal children with JRA and growth retardation received recombina nt human growth hormone (rHuGH) for 1 year, Growth hormone profiles ov er 24 hours were obtained before treatment in 12 patients; the levels did not differ from those in ''short normal'' children, Levels of insu lin-like growth factor 1 (IGF-1), IGF binding proteins (IGFBPs) 1 and 3, insulin, osteocalcin, and C-reactive protein (CRP), as well as the erythrocyte sedimentation rate were measured serially, Pretreatment le vels were compared with control levels. Results, In JRA patients, IGF- 1, IGFBP-3, and osteocalcin levels were significantly lower and insuli n levels significantly higher than those in controls, but there was no significant difference in the level of IGFBP-1, With rHuGH treatment, height velocity and mean levels of IGF-1, osteocalcin, and insulin in creased significantly, while mean levels of IGFBP-1 fell significantly , Levels of IGFBP3 correlated with those of IGF-1, The height velocity correlated positively with IGF-1 and osteocalcin, and negatively with IGFBP-1, Levels of IGFBP-1 were inversely related to those of insulin and IGF-1, There was a significant negative correlation between the C RP and height velocity, IGF-1 level, and osteocalcin level. Conclusion . IGF-1 production is impaired in children with active JRA, Treatment with a therapeutic dose of rHuGH can rectify the IGF-1 deficiency with in 4 days, but its effect is adversely influenced by the acute-phase r esponse, as reflected by an elevated CRP level.