Linear growth and systemic glucocorticoid therapy in children with systemic lupus erythematosus

  • Dikahayu Alifia Anugrah Gadjah Mada University
  • Suryono Yudha Patria Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Central Java
  • Cahya Dewi Satria Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Central Java
Keywords: linear growth; glucocorticoids; children; systemic lupus erythematosus

Abstract

Background The use of long-term oral glucocorticoid therapy, specifically in the treatment of systemic lupus erythematosus (SLE), has increased in the past two decades. Chronic glucocorticoid use may lead to a linear growth disturbances.

Objective To determine the association between linear growth and systemic glucocorticoid therapy in pediatric SLE patients.

Methods This retrospective cohort study used medical record data of pediatric SLE patients. All subjects received systemic glucocorticoids. The linear growth parameters recorded in this study were height-for-age z-score (HAZ) and height velocity at 0, 6, and 12 months of treatment. We recorded potential risk factors of linear growth disturbance, such as pubertal status, sex, SLE severity, pulse methylprednisolone use, daily glucocorticoid dose, and nutritional status.

Results Of 42 patients with SLE, 83.3% were female, with a mean age of 13 years at diagnosis. Eighteen subjects (42.9%) experienced abnormal height velocity. There was a significant reduction in HAZ between 0, 6, and 12 months of treatment (P=0.016). Between 0 and 6 months of treatment, there was a mean HAZ decrease of 0.11 (P=0.015). There was a trend towards a risk for decreased HAZ at 6 and 12 months of treatment with pulse methylprednisolone (RR 1.25 and 1.27, respectively), as well as for abnormal height velocity (RR 1.73), but they did not reach statistical significance.

Conclusion There is a reduction in linear growth in the first 12 months of systemic glucocorticoid therapy in children with SLE. Administration of systemic glucocorticoid significantly reduced HAZ in the first six months of therapy.

References

1. Katzung BG, Masters SB, Trevor AJ. Basic and clinical pharmacology. 12th ed. San Francisco: McGraw Hill; 2011. p. 697-713.
2. Fardet L, Petersen I, Nazareth I. Monitoring of patients on long-term glucocorticoid therapy. Med (Baltimore). 2015;94:1-10. DOI: 10.1097/MD.0000000000000647.
3. Perhimpunan Reumatologi Indonesia. Diagnosis dan pengelolaan lupus eritematosus sistemik. Rekomendasi Perhimpunan Reumatologi Indonesia. Jakarta: Perhimpunan Reumatologi Indonesia; 2011. p.7-9.
4. Pusat Data dan Informasi Kementerian Kesehatan RI. Situasi penyakit lupus di Indonesia. [cited 2020 March 2]. Available from: https://pusdatin.kemkes.go.id/article/view/17072400003/situasi-penyakit-lupus-di-indonesia.html.
5. Thakral A, Klein-Gitelman MS. An update on treatment and management of pediatric systemic lupus erythematosus. Rheumatol Ther. 2016;3:209-19. DOI: 10.1007/s40744-016-0044-0.
6. Mushtaq T, Ahmed SF. The impact of corticosteroids on growth and bone health. Arch Dis Child. 2002;87:93-6. DOI: 10.1136/adc.87.2.93.
7. Lui JC, Baron J. Effects of glucocorticoids on the growth plate. Endocr Dev. 2011;20:187-93. DOI: 10.1159/000321244.
8. Ocejo A, Correa R. Methylprednisolone. 2021 Jul 18. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. PMID: 31335060.
9. Loke YK, Blanco P, Thavarajah M, Wilson AM. Impact of inhaled corticosteroids on growth in children with asthma: systematic review and meta-analysis. PLoS One. 2015;10:e0133428. DOI: 10.1371/journal.pone.0133428.
10. Klein GL. The effect of glucocorticoids on bone and muscle. Osteoporos Sarcopenia. 2015;1:39-45. DOI: 10.1016/j.afos.2015.07.008.
11. Klaus G, Jux C, Fernandez P, Rodriguez J, Himmele R, Mehls O. Suppression of growth plate chondrocyte proliferation by corticosteroids. Pediatr Nephrol. 2000;14:612-5. DOI: 10.1007/s004670000344.
12. Zhang L, Prietsch SO, Ducharme FM. Inhaled corticosteroids in children with persistent asthma: effects on growth. Cochrane Database Syst Rev. 2014;2014:CD009471. DOI: 10.1002/14651858.CD009471.pub2.
13. Kitamura M. Growth retardation in children with frequent relapsing nephrotic syndrome on steroid--improvement in height velocity after administration of immunosuppressive agent. Nihon Jinzo Gakkai Shi. 1992;34:117-24.
14. Wati KDK, Suarta K, Soetjiningsih S. Tinggi badan dan usia tulang sindrom nefrotik yang mendapat terapi steroid jangka panjang. Sari Pediatri. 2002;4:83. DOI: 10.14238/sp4.2.2002.83-7.
15. Sinaga T. Gizi anak sekolah. Hardinsyah, Supariasa IDN, editors. Jakarta: Penerbit Buku Kedokteran EGC; 2014. p. 423-6.
16. Arnelia A, Muljati S, Puspitasari DS. Pencapaian pertumbuhan linear dan status pubertas remaja dengan riwayat gizi buruk pada usia dini. Penel. Gizi Makan. 2010;33:73-82.
17. Lui JC, Baron J. Effect of glucocorticoids on the growth plate. Endocr Dev. 2011;20:187-93. DOI: 10.1159/000321244.
18. UKK Nutrisi dan Penyakit Metabolik, Ikatan Dokter Anak Indonesia. Rekomendasi Ikatan Dokter Anak Indonesia: Asuhan nutrisi pediatrik (Pediatric Nutrition Care). ISBN 978-979-8421-71-6. p. 5-6.
19. Visser K, Houssiau FA, da Silva JAP, van Vollenhoven R. Systemic lupus erythematosus: treatment. Module 18 of EULAR on-line course on rheumatic diseases. [cited 2020 May 4]. Available from: https://www.eular.org/sysModules/sysFiles/ckeditor_4/plugins/doksoft_uploader/userfiles/18_main_CH21.docx_1.pdf. p. 1-46.
20. Dirjen Pelayanan Kesehatan RSUP Dr. Sardjito Yogyakarta. Perubahan atas rencana strategis bisnis (RSB) RSUP Dr . Sardjito Tahun 2015 – 2019. Yogyakarta: RSUP Dr. Sardjito; 2018.
21. Stojan G, Petri M. Epidemiology of systemic lupus erythematosus: an update. Curr Opin Rheumatol. 2018;30:144-50. doi:10.1097/BOR.0000000000000480
22. Gottlieb BS, Ilowite NT. Systemic lupus erythematosus in children and adolescents. Pediatr Rev. 2006;27:323-30. DOI: 10.1016/j.pcl.2012.03.007.
23. dos Santos Fde M, Borges MC, Correia MI, Telles RW, Lanna CC. Assessment of nutritional status and physical activity in systemic lupus erythematosus patients. Rev Bras Reumatol. 2010;50:631-45.
24. Harry O, Yasin S, Brunner H. Childhood-onset systemic lupus erythematosus: a review and update. J Pediatr. 2018;196:22-30.e2. DOI: 10.1016/j.jpeds.2018.01.045.
25. Briot K, Roux C. Glucocorticoid-induced osteoporosis. RMD Open. 2015;1:e000014. DOI: 10.1136/rmdopen-2014-000014.
26. Townsend HB, Saag KG. Glucocorticoid use in rheumatoid arthritis: Benefits, mechanisms, and risks. Clin Exp Rheumatol. 2004;22:S77-82. PMID: 15552519.
Published
2022-02-04
How to Cite
1.
Anugrah D, Patria S, Satria C. Linear growth and systemic glucocorticoid therapy in children with systemic lupus erythematosus. PI [Internet]. 4Feb.2022 [cited 23Nov.2024];62(1):37-3. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2581
Section
Pediatric Endocrinology
Received 2021-01-08
Accepted 2022-02-04
Published 2022-02-04