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Get an early start on fighting JRA osteopenia. (Prevent Later Fractures, Osteoporosis).

SNOWMASS, COLO. -- Treat bone loss that accompanies juvenile rheumatoid arthritis early during the prime bone-building years of youth, to prevent later fractures and osteoporosis, Dr. James T. Cassidy said at a symposium sponsored by the American College of Rheumatology.

A recent study that compared 65 adults who had a history of juvenile chronic arthritis with control adults who had no history of childhood arthritis found significantly less spinal and hip bone density and continued abnormalities in serum markers of bone resorption and formation in the subjects who had had juvenile arthritis (Arthritis Rheum. 43[3]:710, 2000). The childhood disease put them at risk to develop premature osteoporosis and fractures, said Dr. Cassidy, chief of pediatric rheumatology at the University of Missouri--Columbia.

Other studies have shown that problems with development of bone mineral density affect all children with juvenile rheumatoid arthritis regardless of the severity of their disease.

"Whatever we might do to repair these defects in bone mineral density, we need to do [it] during the maximum period of skeletal growth, which is generally around age 10 or even before." What's going to happen in the later teenage years and adulthood is probably irreparable, he said.

A 1-year study by Dr. Cassidy and his associates showed that treatment with high-dose calcium and vitamin D did not improve bone mineral content in girls with juvenile rheumatoid arthritis, probably because the study was too short to assess a long-term effect. "I think that vitamin D and calcium are efficacious," he added.

A recent Italian study compared results of repeat bone mineral density scans in 16 children with juvenile rheumatoid arthritis before and after treatment with alendronate and in 23 control patients with the disease. Bone mineral density increased by 15% in the treated patients, putting 13 of 16 into the normal range for their age. Among control patients, bone mineral density continued to decrease in 15 and was unchanged in 23, he said.

Alendronate is not approved in the United States to treat or prevent bone loss in juvenile rheumatoid arthritis but "probably is being used" in this way, Dr. Cassidy said. The drug is unlikely to gain approval for this indication any time soon, until concerns about potential toxicities--especially in women--are put to rest, he added.

Data on long-term outcomes in juvenile rheumatoid arthritis come from the end of the era that used gold as the primary treatment and from the beginning of the methotrexate era. The disease remained active in 45% of patients followed 15-20 years after diagnosis, and 17% reported very poor functional capacity, a 1992 study found.

A more recent British study reached nearly the same conclusions, with arthritis still active in 43% of 246 patients followed an average of 28 years after diagnosis (Rheumatology 41[12]:1428-44, 2002). C-reactive protein levels remained increased in 54%. Although patients in general obtained a higher educational level than matched controls, their unemployment rate was twice the national average. Severe pain in adulthood was reported by 33%, anxiety by 32%, depression by 5%, and previous depression by 21%.

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Author:Boschert, Sherry
Publication:Pediatric News
Geographic Code:1USA
Date:Apr 1, 2003
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