Growth and development abnormalities in children with juvenile idiopathic arthritis: treatment and prevention.

摘要

In 1897, in the Transactions of the Royal Medical and Surgical Society of London, Sir George Frederic Still described for the first time the devastating consequences on growth and development of a special form of childhood arthritis: 'A remarkable feature in these cases is the general arrest of development that occurs when the disease begins before the second dentition. A child of twelve and a half years would easily have been mistaken for six or seven years while another of four years looked more like two and a half or three years.' Haif a century later, the introduction of glucocorticoid therapy radically improved the course of Still's disease (now called juvenile idiopath-ic arthritis [JIA]) and alleviated the pain so frequently experienced by affected children. However, glucocorti-coids were soon found to worsen the slowing of growth and development. A Cushing-like appearance became a clinical feature of severe long-lasting JIA. Nevertheless, the deleterious effects of JIA on growth were recognized long before the advent of glucocorticoid therapy.