Insulin-like growth factor and growth hormone secretion in juvenile chronic arthritis

Article Abstract:

Children with juvenile chronic arthritis, a disorder that includes juvenile rheumatoid arthritis, tend to grow poorly. This occurs independently of steroid treatment, which also has the potential to affect growth. Normal growth in children results from the action of growth hormone, made by the pituitary, and its stimulation of insulin-like growth factors (IGF), especially IGF-1. Although growth hormone levels have been reported normal in previous studies of children with juvenile chronic arthritis, additional treatment with hormone increased the growth rate. Studies have disagreed on levels of IGF-1 in children with the disorder. To better understand any hormonal effects on growth in children with chronic arthritis, levels of growth hormone and IGF-1 were studied in 23 children (15 female). Average heights and weights of the children were significantly lower than normal. Children who had arthritis for over four years had significantly lower weight and height. Eight patients had low blood levels of IGF-1, and this was not related to subtype of disease. Seven of these patients and three others with poor growth rates were studied overnight. Average secretion of growth hormone was greater than that of previously studied children who were growth hormone-deficient, and of children of short stature. However, seven of the 10 children studied had growth hormone secretion within the range of the hormone-deficient group. The hormone tended to be secreted in more frequent pulses than is normal. IGF-1 deficiency was significantly associated with decreased weight. IGF-1 levels did not correlate with growth hormone levels, and may reflect influences of other factors such as nutrition. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Physiological aspects, Somatotropin, Insulin-like growth factor 1, Insulin-like growth factor I, Stature, Short, Short stature

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Cardiac tamponade in juvenile chronic arthritis: report of two cases and review of publications

Article Abstract:

Juvenile chronic arthritis is a chronic inflammatory disease, which may cause joint or connective tissue damage and lesions of the internal organs. The disease commonly occurs before the age of 16 years, and complete remission is seen in 75 percent of patients. Juvenile chronic arthritis may be complicated by the development of pericarditis, the inflammation of the pericardium (membrane surrounding the heart). Pericarditis produces very mild or no symptoms, which resolve completely in most patients with arthritis. Because of the few symptoms of pericarditis, it is often difficult to diagnose this disorder. Autopsy studies show that the incidence of pericarditis in juvenile chronic arthritis is high, ranging from 30 to 50 percent. A rare complication of pericarditis associated with juvenile chronic arthritis is cardiac tamponade, the accumulation of excess fluid in the pericardium; two cases are described, and eight previously reported cases are reviewed. The clinical characteristics and findings of diagnostics tests including X-ray, electrocardiography, and echocardiography were similar in all cases. Two patients were treated with corticosteroid agents and underwent surgical removal of the pericardium. One of these patients died of infection 30 days after surgery, and the other died of ventricular tachycardia, an abnormally rapid heart rate arising in the ventricles of the heart. Only 6 of 10 cases of cardiac tamponade associated with juvenile chronic arthritis were successfully treated. A favorable outcome of this disorder is only possible with early diagnosis and treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies

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Pseudomonas pericarditis and tamponade in an infant with human immunodeficiency virus infection

Article Abstract:

Pseudomonas aeruginosa infection in HIV-positive children can have serious effects on the heart. An 11-month-old HIV-infected girl was admitted for fever, rapid heartbeat, and rapid breathing. An echocardiogram revealed enough fluid to compress the heart filling the sac that encloses the heart. The fluid was drained, and cultures grew P aeruginosa. While researchers report cases of P aeruginosa infection in HIV-infected children, no cases of this complication appear in the literature. However, imaging studies of the heart in symptomatic HIV-infected children have reported that fluid build-up around the heart is not uncommon.

HIV infection in children, Pediatric HIV infections, Pseudomonas infections

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