The short end of JIA:  How biologics improved Trevor’s growth

Trevor was diagnosed before the age of two. Pale, irritable and tired, he endured many years of relentless JIA that was showing little, if any, response to prescribed treatment regimes. Over the next few years, his younger brother caught up and eventually surpassed his height and weight parameters. For many years his growth chart showed only marginal improvement, far below normal. By the time he reached his teens and was starting junior high, he still had the stature of a little boy, was taken to be much younger than his stated age, and was a target of bullying. Enbrel was added to his drug arsenal, but by the time these biologics were available, his growth plates were almost closed.

Now in high school, Trevor remains well below his predicted height despite several disease modifying anti rheumatic drugs (DMARDs), steroid joint injections, and the eventual use of growth hormones. Coping skills have been developed to deal with teasing and to maintain his self-confidence and self-esteem. He continues to embrace life, do well in school, and accept life, size challenges and disability with spirit and a perpetual smile. However, not all children are this fortunate and the psychosocial issues related to chronic illness, short stature and distorted body image follow into adulthood.

Recently researchers in Helsinki, Finland, published a report in the January 2006 Annuls of Rheumatic Disease, on TNF inhibitors impact on growth velocity in children with JIA. The research, done over four years with 71 JIA patients indicated that the use of TNF inhibitors (Enbrel or Remicade) not only reduced inflammation but also restored growth velocity in these patients. The children with the worst growth delays gained the most from the use of these medications; those children with normal growth parameter prior to TNF treatment had no significant changes to growth during treatment.

In this clinical study, the change in inflammatory activity remained a significant predictor of the growth velocity even after the use of steroids were taken into account. Researchers believe the improvements in growth velocity may be accounted for by the decrease in inflammation and not by a direct effect of biologic agents on growth or skeletal maturation. They have concluded that TNF inhibitors "not only suppress inflammation but also restore growth velocity".

What exciting news for JIA patients (and their families), with severe, unrelenting, polyarticular disease - patients who are refractory to conventional disease-modifying antirheumatic drugs, like Trevor profiled at the beginning of this article!! Let’s all make an effort to lobby governments at all levels to appreciate that the use of the biologic "big guns" early in the disease can make a HUGE difference to many aspects of life and well being. These benefits will surely far outweigh the costs of treatment in the long run.