Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


Growth in a UK Cohort of Juvenile Idiopathic Arthritis (JIA) Patients Treated with Etanercept and/or Methotrexate

Southwood1,  Taunton R., Cummins1,  Carole, Cotter1,  Kate, British Society of Paediatric and Adolescent Rheumatology2,  

University of Birmingham and Birmingham Childrens Hospital, Birmingham, United Kingdom

Purpose:

Since 2004, the British Society for Paediatric and Adolescent Rheumatology (BSPAR) Biologics and New Drug Register has enrolled and monitored JIA patients treated with etanercept and/or methotrexate. Here we report change in height standard deviation scores (SDS) after monitoring for 2 years.

Method:

After informed consent, JIA patients treated with etanercept and/or methotrexate were enrolled and disease subtype/activity, growth parameters, co-morbidity, treatment efficacy and safety data were recorded at baseline, 3 and 6 months and annually thereafter. Height and weight SDS, BMI and International Obesity Taskforce cut-offs were calculated from British 1990 growth charts and Excel add-on program LMS Growth 2.64 (H Pan & T Cole). Patients with missing/erroneous measurements were excluded.

Results:

702 JIA patients were enrolled from 29 UK centres (67% female, 13% systemic arthritis). Height SDS for the cohort and treatment groups at baseline (table 1) were left skewed; there was a moderate correlation with disease duration (r=- 0.255, p<0.01). 21% of the cohort were thin (23% of systemic arthritis patients had grade 3 thinness), 18% were overweight or obese.

Table 1. Height SDS at baseline

Treatment group at baselinenAge at baselineHeight SDS (mean ± SD)
Etanercept alone22111.0 ± 3.5-0.74 ± 1.35
Etanercept and Methotrexate31511.2 ± 4.37-0.86 ± 1.43
Methotrexate alone1668.0 ± 4.75-0.13 ± 1.38 (P < 0.001)

Girls (- 0.83 ± 1.26) had a lower height SDS than boys (- 0.39 ± 1.55) (p<0.001). Patients with systemic arthritis were shorter than other forms of JIA (mean SDS -1.42 ± 1.47) and were more likely than others to be treated with both etanercept and methotrexate, p<0.001). Height monitoring data at 1 year follow up was available in 338 patients (table 2). The mean difference in height SDSs between baseline and 2 years for all patients with both measurements (n=201) was 0.278 (paired t test p<0.001).

Table 2. Change in Height SDS after monitoring for 1 and 2 years

Treatment group at baseline1 year after baseline (n=338)2 years after baseline (n=201)
 nmean ± SDnmean ± SD
Etanercept alone1070.54 ± 0.86680.31 ± 0.94
Etanercept and Methotrexate1480.45 ± 0.71960.35 ± 0.86
Methotrexate alone830.12 ± 0.79370.02 ± 1.43
  P = 0.001 NS

Conclusion:

Children with JIA starting etanercept and/or methotrexate were shorter than expected and significant proportions were either thin or overweight/obese. After two years, there was an improvement in height SDS for the whole cohort. A statistically significant increase in height gain was seen in etanercept and combined etanercept/methotrexate treated patients compared with patients treated with methotrexate alone at one year but not at 2 years, possibly due to lower patient numbers. There is potential for confounding by pubertal stage and associated growth spurts as final adult height has not yet been measured and children treated with methotrexate alone were younger than those on etanercept.

To cite this abstract, please use the following information:
Southwood, Taunton R., Cummins, Carole, Cotter, Kate, British Society of Paediatric and Adolescent Rheumatology2, ; Growth in a UK Cohort of Juvenile Idiopathic Arthritis (JIA) Patients Treated with Etanercept and/or Methotrexate [abstract]. Arthritis Rheum 2009;60 Suppl 10 :245
DOI: 10.1002/art.25328

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