ContextMusculoskeletal symptoms occur in up to 30 % of children. Juvenile Idiopathic Arthritis (JIA) is one of the most common reasons for these symptoms. Glucocorticoids, wh have various side effects, since they influence multiple organ systems. In children, these adverse effects have an extra impact in that they can significantly impair growth when used before ch are used in JIA. Bone mineralization is also affected by glucocorticoids, which may significantly impair peak bone mass if used as long-term therapy before the age of 30.
ObjectiveFor these reasons I have chosen to review literature on long-term adverse effects of glucocorticoids when used in children with Juvenile Idiopathic Arthritis before puberty.
Data SourcesEnglish, Norwegian, German, French, Swedish and Danish-language articles regarding JIA and adverse effects of corticosteroids, with special regards to bone mineralization, growth retardation, and psychic adverse effects, were searched using Medline, EMBASE, Pub Med, The Cochrane database, and NEL. Abstracts and articles in full text were chosen from composed searches.
Data Synthesis and ConclusionsTaken together, the data reported in the literature show that the administration schedule, dosage, and duration of medication determine the frequency, extent and seriouseness of the adverse effects have. Several studies showed discrepant results as to whether alendronate counteracts the reduction in bone mineral content. There seems to be a general consensus, however, that the use of growth hormone can help reduce growth retardationMost of the literature is in consensus in that glucocorticoid therapy is the best alternative for Juvenile Idiopathic Arthritis, especially for the systemic subtype. The dispute is over the dosage, pulse therapy or not, and ways to reduce the magnitude of the adverse effects.