Growth and weight gain in children with juvenile idiopathic arthritis: results from the ReACCh-Out cohort

Guzman, Jaime; Kerr, Tristan; Ward, Leanne M.; Ma, Jinhui; Oen, Kiem; Rosenberg, Alan M.; Feldman, Brian M.; Boire, Gilles; Houghton, Kristin; Dancey, Paul; Scuccimarri, Rosie; Bruns, Alessandra; Huber, Adam M.; Watanabe Duffy, Karen; Shiff, Natalie J.; Berard, Roberta A.; Levy, Deborah M.; Stringer, Elizabeth; Morishita, Kimberly; Johnson, Nicole; Cabral, David A.; Larché, Maggie; Petty, Ross E.; Laxer, Ronald M.; Silverman, Earl; Miettunen, Paivi; Chetaille, Anne-Laure; Haddad, Elie; Spiegel, Lynn; Turvey, Stuart E.; Schmeling, Heinrike; Lang, Bianca; Ellsworth, Janet; Ramsey, Suzanne E.; Roth, Johannes; Campillo, Sarah; Benseler, Susanne; Chédeville, Gaëlle; Schneider, Rayfel; Tse, Shirley M. L.; Bolaria, Roxana; Gross, Katherine; Feldman, Debbie; Cameron, Bonnie; Jurencak, Roman; Dorval, Jean; LeBlanc, Claire; St. Cyr, Claire; Gibbon, Michele; Yeung, Rae S. M.; Duffy, Ciarán M.; Tucker, Lori B.

doi:10.1186/s12969-017-0196-7

Pediatric Rheumatology

Table 3 Impact of corticosteroid use, disease activity and covariates on height Z-scores and BMI Z-scores

From: Growth and weight gain in children with juvenile idiopathic arthritis: results from the ReACCh-Out cohort

	Impact on height Z-scores				Impact on BMI Z-scores
Variable	Unadjusted^a (95% CI)	p value	Adjusted (95% CI)	p value	Unadjusted (95% CI)	p value	Adjusted (95% CI)	p value
Cumulative corticosteroids^b	−0.69 (−0.82, −0.56)	<0.01	−0.64 (−0.77, −0.50)	<0.01	0.79 (0.63, 0.96)	<0.01	0.74 (0.56, 0.92)	<0.01
Cumulative disease activity^c	−0.02 (−0.03, −0.01)	<0.01	−0.01 (−0.02, 0.00)	0.04	0.00 (−0.01, 0.01)	0.49	−0.01 (−0.02, 0.00)	0.17
Parental education^d
Less than high school	Reference		Reference		Reference		Reference
High school/secondary	0.29 (−0.18, 0.77)	0.23	0.31 (−0.18, 0.80)	0.21	0.005 (−0.50, 0.51)	0.98	0.09 (−0.43, 0.61)	0.73
Some post-secondary	0.34 (−0.12, 0.80)	0.15	0.39 (−.08, 0.87)	0.11	−0.01 (−0.50, 0.48)	0.96	0.09 (−0.41, 0.60)	0.72
University degree	0.32 (−0.14, 0.78)	0.18	0.36 (−0.11, 0.84)	0.14	−0.17 (−0.66, 0.31)	0.49	−0.08 (−0.58, 0.43)	0.77
Postgraduate degree	0.40 (−0.08, 0.89)	0.10	0.43 (−0.07, 0.93)	0.09	−0.25 (−0.76, 0.26)	0.33	−0.11 (−0.64, 0.42)	0.68
Primary Ethnicity^e
British	Reference		Reference		Reference		Reference
French	−0.09 (−0.26, 0.09)	0.32	−0.11 (−0.29, 0.07)	0.24	−0.36 (−0.55, −0.17)	<0.01	−0.33 (−0.52, −0.13)	<0.01
Indigenous Canadian	0.15 (−0.15, 0.45)	0.34	0.15 (−0.16, 0.46)	0.33	−0.05 (−0.37, 0.27)	0.76	−0.03 (−0.36, 0.30)	0.84
Other European	0.03 (−0.14, 0.19)	0.74	0.03 (−0.14, 0.20)	0.75	−0.31 (−0.49, −0.13)	<0.01	−0.23 (−0.41, −0.05)	0.01
South Asian	0.33 (0.0, 0.66)	0.05	0.34 (0.0, 0.67)	0.05	−0.13 (−0.48, 0.22)	0.47	−0.13 (−0.49, 0.23)	0.48
Other	−0.07 (−0.27, 0.13)	0.47	−0.03 (−0.24, 0.18)	0.75	−0.23 (−0.44, −0.02)	0.03	−0.13 (−0.35, 0.09)	0.25
JIA categories
Oligoarthritis	Reference		Reference		Reference		Reference
RF-neg polyarthritis	−0.17 (−0.34, −0.01)	0.04	−0.14 (−0.32, 0.03)	0.10	−0.01 (−0.18, 0.17)	0.96	0.00 (−0.18, 0.19)	0.99
Enthesitis-related	0.17 (−0.01, 0.36)	0.07	0.21 (0.01, 0.40)	0.04	0.08 (−0.12, 0.27)	0.45	−0.04 (−0.25, 0.18)	0.74
Systemic	−0.36 (−0.61, −0.10)	0.01	−0.23 (−0.51, 0.05)	0.10	0.68 (0.41, 0.95)	<0.01	0.44 (0.15, 0.74)	<0.01
Psoriatic	0.04 (−0.23, 0.30)	0.79	0.16 (−0.12, 0.44)	0.26	0.41 (0.13, 0.69)	<0.01	0.31 (0.01, 0.61)	0.05
RF-pos polyarthritis	−0.13 (−0.46, 0.19)	0.43	−0.03 (−0.36, 0.31)	0.88	−0.13 (−0.47, 0.21)	0.46	−0.25 (−0.60, 0.10)	0.17
Undifferentiated	−0.18 (−0.39, 0.04)	0.11	−0.11 (−0.33, 0.12)	0.37	0.03 (−0.20, 0.25)	0.82	0.02 (−0.22, 0.26)	0.86

^aUnadjusted Beta coefficients and (95% CI) were obtained from mixed effect models including only one independent variable at a time. Adjusted beta coefficients are from a mixed effects model where cumulative corticosteroids in previous 6 months, cumulative disease activity in previous 6 months, parental education, ethnicity and JIA category were entered together. Cumulative prednisone and disease activity were time-variant variables. All mixed effects models were run by subject and included random intercept, random slope and a quadratic term for time since diagnosis in weeks. They can be represented by: dependent variable = b1*constant + b2*time + b3*time square + b4* first independent variable + b5* second independent variable
^bCumulative corticosteroids were calculated as area under the curve of daily prednisone equivalents per kilogram of body weight recorded at each clinic visit, using the trapezoid method; a one unit change corresponds to an increase of 1 mg/Kg of prednisone equivalents per day sustained for 6 months. For the first study visit, corticosteroids were assumed to start at diagnosis
^cCumulative disease activity was calculated as area under the curve of the physician global assessment of disease activity recorded at each clinic visit, using the trapezoid method; a one unit change corresponds to an increase of 1 cm in the physician global assessment sustained for 6 months. For the first study visit the physician global assessment was assumed to be zero the day before disease onset
^dThe level of education of the parent who had a higher level of education
^eThe ethnic group listed first; up to six ethnic groups could be listed for each child as defined by Statistics Canada

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ISSN: 1546-0096

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