Abnormalities in skeletal growth in children with juvenile rheumatoid arthritis

Osteopenia, or low bone mass for age, has emerged as a major determinant of the functional outcome of children with chronic rheumatic diseases. Historically, local and general (linear) growth retardation have been recognized in children with juvenile rheumatoid arthritis (JRA).(7,15,87) Juxta-articular osteopenia was an early radiographic change with generalized demineralization developing later.(87) Although vertebral compression fractures and fractures of long bones were regarded as frequent clinical outcomes in these children,(10,37,87,142) a decrease in skeletal mass could not be documented early in disease, or quantitated, until after the introduction of absorptiometry into clinical assessment. This review is limited to recent data on osteopenia in JRA because few studies of other rheumatic diseases have been published. These investigations can be summarized to conclude that (1) the cortical appendicular skeleton is affected more, or at least as much as axial trabecular bone, (2) impaired development of a normal bone mass is characteristic of these children and constitutes a failure of bone formation over resorption, (3) the defect is accentuated during pubertal growth, and (4) the degree of osteopenia is correlated with the activity and severity of the disease. Conversely, therapeutic interventions will be most successful if they adequately suppress disease severity and are started before adolescent growth acceleration.