الفهرس 
Juvenile Idiopathic ArthritisOnly 14 pages are availabe for public view
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Abstract
Impairment of Growth can result in JIA, which is defined as body height in the lowest third percentile of the population, or body height more than two standard deviations below the mean for the population.
Normal growth is a complex interrelation of factors, including genetic, hormonal, and nutritional requirements. In the presence of normal thyroid function, the secretion of pituitary growth hormone and the growth hormone dependent insulin-like growth factors (IGF), particularly IGF-1, form the predominant hormonal axis of postnatal growth. Insulin-like growth factor 1 (IGF1) is an important determinant of muscle mass because it promotes growth and suppresses protein degradation. IGF1 is decreased in rheumatoid arthritis and juvenile idiopathic arthritis because its synthesis is inhibited by inflammation.
IGF-1, also called somatomedin C is a protein that acts as a primary mediator of the effects of growth hormone GH, it stimulates systemic body growth, and has growth promoting effects on almost every cell in the body, especially skeletal muscle, cartilage and bone. In addition to insulin like effects, IGF-1 can also regulate cell growth and development especially in nerve cells as well as cellular DNA synthesis. IGF-1 is produced throughout life. The highest rates of IGF-1 production occur during the pubertal growth spurt, the lowest level occur in infancy and old age.
S 1008/9 protein also known as Calprotectin is proinflammatory and Ca++ binding protein. This protein is complex and secreted after activation of phagocyte and endothelial cells and it is associated with acute and chronic inflammatory disorder. The S100 A8/9 protein has recently been proposed as ”alarmins” which is the endogenous molecule that signal the early phase of tissue and cell damage.
There is a close relation between S1008/9 protein and clinical and laboratory markers of disease activity that has been demonstrated in patient with JIA. The S100 A 8/9 protein is currently the most promising potential biomarker of disease activity and response to therapy in JIA and can detect the subclinical inflammation.
The aim of this work were to:
1. Evaluation the physical growth pattern in children with JIA by performing anthropometric measurements and interpretation of results using growth charts.
2. Measuring the level of serum IGF-1 in children with JIA and comparing with healthy controls subjects.
3. Assessment of serum S100 A 8/9 protein and its relation to the disease activity, growth pattern and IGF-1.
Patients and methods:
The study was a case control study which included 40 patients of both sexes with (JIA), their ages will range from 6-10 years. All cases were meet the diagnostic criteria as defined by ”International league of Association for Rheumatology” [ILAR].Control: 40 healthy children will serve as a control group.
Selection criteria for patients:
c- Inclusion criteria:
Diagnostic Criteria for JIA by the ”International league of Association for Rheumatology ”[ILAR].
• Arthritis in at least one Joint.
• Arthritis that last for at least 6 weeks.
• Age of onset from 6-10 years before puberty.
d- Exclusion criteria:
• Cases diagnosed with JIA and associated with another chronic disease (e.g. chronic renal failure, cardiac diseases chronic chest disease and endocrinal disease) that may interfere with normal growth.
• Other causes of arthritis were excluded (septic arthritis- rheumatic heart disease).
• Patients with clinical signs of acute infection or inflammation on the day of taking the blood sample.
• Genetics diseases.
Ethical aspects:
• Care givers of children were informed of the nature and aims of the study, plain simple explanation of the procedures of the study will be introduced.
• Written informed consent was obtained from care givers to in roll their children in the study.
Methods:
All patients and controls were subjected to the following:-
3- Complete history taking:
4- Complete Clinical Examination:
5- Growth Assessment: including
a) Weight
b) Height
c) BMI:
Each of these measurements was taken as the mean of three consecutive accepted reading, following the recommendations of the international biological program using standard equipment and was interpreted with reference to Egyptian growth charts.
4- Laboratory investigations:
All patients and controls were subjected to measurement of:
Measurement of (IGF-1) hormone level:
Measurement of S100 A8/9 protein
Complete blood count (CBC).
Erythrocyte sedimentation rate
Determination of serum C-Reactive Protein (CRP)
This study showed that:
Our study showed obvious female predominance.
This study showed that, aamong JIA children, fever was present in (77.5%) patients.
In the present work, there was statistically significant decrease in hemoglobin among Cases versus Controls. Percentage of anemia was statistically significant higher among cases than controls (87.5% versus 57.5%).
There was statistically significant decrease in Height among Cases versus Controls. There was statistically significant difference between Cases and Controls regarding height-for-age z-score (HAZ), 37.5% of cases were short stature while only 10% among controls.
There was statistically significant decrease in Weight and BMI among Cases versus Controls. percentage of underweight of cases were higher among cases versus controls.
There was statistically significant increase in ESR and CRP among Cases than Controls.
There was statistically significant decrease in Insulin-like growth factor 1 among Cases than Controls.
There was statistically significant increase in S100A8/9 Protein among Cases than Controls
There were statistically significant positive correlation between IGF-1 and height.
There was statistically significant decrease in IGF-1 ng/ml among males than females.