Final height, armspan, subischial leg length and body proportions in juvenile chronic arthritis - A long-term follow-up study

Objective: Assessment of growth disturbances in adults with a history of ju venile chronic arthritis (JCA). Material and Methods: Sixty-five subjects, 52 premenopausal females and 13 males with a mean age (range) of 32.2 years (22.3-49.4) participated. Mean age at disease onset was 5.7 years (0.8-15. 8) and mean disease duration was 12.4 years (0.4-32). The follow-up time ra nged from 18.7 to 46.9 years with a mean of 26.4 years. For each participan t standard deviation scores (z-scores) for final height, delta-height (the difference between observed and expected height), armspan, subischial leg l ength and sitting height ratio, were calculated. Results: The study group a s a whole did not exhibit linear growth impairment. The categorical distrib ution of heights differed significantly from a expected distribution in a h ealthy population (p < 0.001). A height z-score <-2 SD was present in 10.7% of the study group, of whom all had polyarticular course of JCA. Polyartic ular and systemic course of JCA (versus pauciarticular) (p = 0.022), system ic steroid treatment (p = 0.006) and Steinbrocker functional class II-IV (v s. I) in 1979 (p = 0.043) were variables associated with reduced delta-heig ht. In linear regression analyses, disease severity defining variables were statistically significant predictors of reduced final height and armspan. 27% of the study subjects had significantly reduced arm span (p < 0.001). S ubischial leg length and body proportions (sitting height ratio) were norma l. Conclusion: Our findings suggest that functionally impaired polyarticula r and systemic JCA patients treated with systemic steroids may be at an inc reased risk of developing reduced final height and armspan. Disease control achieved by an aggressive therapeutic approach, if possible with a minimal use of systemic steroids, may reduce growth impairment in JCA. Copyright ( C) 2000 S. Karger AG, Basel.