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. 1995 Mar;54(3):193–196. doi: 10.1136/ard.54.3.193

Reduced bone mineral content and normal serum osteocalcin in non-steroid-treated patients with juvenile rheumatoid arthritis.

C Polito 1, C G Strano 1, L Rea 1, M Alessio 1, C S Iammarrone 1, N Todisco 1, A Marotta 1, E Iaccarino 1, M Pirozzi 1
PMCID: PMC1005555  PMID: 7748017

Abstract

OBJECTIVES--To distinguish the effects of juvenile rheumatoid arthritis (JRA) on bone mineralisation from those possibly caused by steroid therapy. METHODS--Bone mineral status was evaluated in 20 children (five boys and 15 girls) with active JRA who never received steroids. Seven had oligoarticular, nine had polyarticular, and four had systemic JRA. Bone mineral content (BMC) was assessed by single beam photon absorptiometry and expressed as a Z score relative to normal values in healthy children. Serum calcium, phosphate, and alkaline phosphatase were measured by colorimetric methods. Whole parathyroid hormone was assayed by Immuno Radiometric Assay. Serum osteocalcin was measured by specific radioimmunoassay. Nutrient intake was assessed by a 24 hours dietary recall. BMC and nutrient intake were also assessed in an age and sex matched control group. RESULTS--BMC was -1.5 (SEM 0.8) Z scores in patients and 0.4 (0.3) in the control group (p = 0.02). BMC averaged -4.9 (2) Z scores in the systemic JRA group, -1 (0.6) in the polyarticular group and 0.3 (0.7) in oligoarticular JRA patients. Serum calcium, phosphate and osteocalcin values were normal in all patients. No significant difference was found between JRA patients and controls in calcium, phosphate, energy, and protein intake. CONCLUSION--JRA subjects have significantly reduced BMC even in the absence of any steroid therapy. Bone demineralisation appears to depend more on disease activity and on reduced motility than on reduced nutrient intake.

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Selected References

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  1. Bacon M. C., White P. H., Raiten D. J., Craft N., Margolis S., Levander O. A., Taylor M. L., Lipnick R. N., Sami S. Nutritional status and growth in juvenile rheumatoid arthritis. Semin Arthritis Rheum. 1990 Oct;20(2):97–106. doi: 10.1016/0049-0172(90)90022-8. [DOI] [PubMed] [Google Scholar]
  2. Bardare M., Bianchi M. L., Furia M., Gandolini G. G., Cohen E., Montesano A. Bone mineral metabolism in juvenile chronic arthritis: the influence of steroids. Clin Exp Rheumatol. 1991 Jan-Feb;9 (Suppl 6):29–31. [PubMed] [Google Scholar]
  3. Boyle I. T. Bones for the future. Acta Paediatr Scand Suppl. 1991;373:58–65. doi: 10.1111/j.1651-2227.1991.tb18152.x. [DOI] [PubMed] [Google Scholar]
  4. Compston J. E., Crawley E. O., Evans C., O'Sullivan M. M. Spinal trabecular bone mineral content in patients with non-steroid treated rheumatoid arthritis. Ann Rheum Dis. 1988 Aug;47(8):660–664. doi: 10.1136/ard.47.8.660. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Ekenstam E. A., Ljunghall S., Hällgren R. Serum osteocalcin in rheumatoid arthritis and other inflammatory arthritides: relation between inflammatory activity and the effect of glucocorticoids and remission inducing drugs. Ann Rheum Dis. 1986 Jun;45(6):484–490. doi: 10.1136/ard.45.6.484. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Elsasser U., Wilkins B., Hesp R., Thurnham D. I., Reeve J., Ansell B. M. Bone rarefaction and crush fractures in juvenile chronic arthritis. Arch Dis Child. 1982 May;57(5):377–380. doi: 10.1136/adc.57.5.377. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Gevers G., Devos P., De Roo M., Dequeker J. Increased levels of osteocalcin (serum bone Gla-protein) in rheumatoid arthritis. Br J Rheumatol. 1986 Aug;25(3):260–262. doi: 10.1093/rheumatology/25.3.260. [DOI] [PubMed] [Google Scholar]
  8. Haugen M. A., Høyeraal H. M., Larsen S., Gilboe I. M., Trygg K. Nutrient intake and nutritional status in children with juvenile chronic arthritis. Scand J Rheumatol. 1992;21(4):165–170. doi: 10.3109/03009749209099216. [DOI] [PubMed] [Google Scholar]
  9. Haugen M., Kjeldsen-Kragh J., Nordvåg B. Y., Førre O. Diet and disease symptoms in rheumatic diseases--results of a questionnaire based survey. Clin Rheumatol. 1991 Dec;10(4):401–407. doi: 10.1007/BF02206660. [DOI] [PubMed] [Google Scholar]
  10. Hermann E., Aeschlimann A., Müller W. Serum-Osteokalzin bei chronischer Polyarthritis im Stadium III. Z Rheumatol. 1987 May-Jun;46(3):129–131. [PubMed] [Google Scholar]
  11. Hopp R., Degan J., Gallagher J. C., Cassidy J. T. Estimation of bone mineral density in children with juvenile rheumatoid arthritis. J Rheumatol. 1991 Aug;18(8):1235–1239. [PubMed] [Google Scholar]
  12. Laan R. F., Buijs W. C., Verbeek A. L., Draad M. P., Corstens F. H., van de Putte L. B., van Riel P. L. Bone mineral density in patients with recent onset rheumatoid arthritis: influence of disease activity and functional capacity. Ann Rheum Dis. 1993 Jan;52(1):21–26. doi: 10.1136/ard.52.1.21. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Miller M. L., Chacko J. A., Young E. A. Dietary deficiencies in children with juvenile rheumatoid arthritis. Arthritis Care Res. 1989 Mar;2(1):22–24. doi: 10.1002/anr.1790020106. [DOI] [PubMed] [Google Scholar]
  14. Pettipher E. R., Henderson B., Edwards J. C., Higgs G. A. Effect of indomethacin on swelling, lymphocyte influx, and cartilage proteoglycan depletion in experimental arthritis. Ann Rheum Dis. 1989 Aug;48(8):623–627. doi: 10.1136/ard.48.8.623. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Ratner D., Eshel E., Vigder K. Juvenile rheumatoid arthritis and milk allergy. J R Soc Med. 1985 May;78(5):410–413. doi: 10.1177/014107688507800515. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Reed A., Haugen M., Pachman L. M., Langman C. B. 25-Hydroxyvitamin D therapy in children with active juvenile rheumatoid arthritis: short-term effects on serum osteocalcin levels and bone mineral density. J Pediatr. 1991 Oct;119(4):657–660. doi: 10.1016/s0022-3476(05)82424-2. [DOI] [PubMed] [Google Scholar]
  17. Saggese G., Federico G., Ghirri P., Cipriani J., Bertelloni S., Igli Baroncelli G. Densitometria ossea in età pediatrica. Valori normali tra 2 e 19 anni. Primi dati italiani. Minerva Pediatr. 1986 Jul 31;38(13-14):545–551. [PubMed] [Google Scholar]
  18. Schaller J. G. Corticosteroids in juvenile rheumatoid arthritis. Arthritis Rheum. 1977 Mar;20(2 Suppl):537–543. [PubMed] [Google Scholar]
  19. Stapleton F. B., Noe H. N., Jerkins G., Roy S., 3rd Urinary excretion of calcium following an oral calcium loading test in healthy children. Pediatrics. 1982 May;69(5):594–597. [PubMed] [Google Scholar]
  20. Tanner J. M., Whitehouse R. H. Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty. Arch Dis Child. 1976 Mar;51(3):170–179. doi: 10.1136/adc.51.3.170. [DOI] [PMC free article] [PubMed] [Google Scholar]

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