The Study Of Glucorticosteroid’s Effects On Serum 25（OH）D₃ Level In SoJIA

Juvenile Idiopathic Arthritis is the most common rheumatoid disease among teenagers. In different studies, the incidence fluctuates between 30-100/100000. Systemic-Onset Juvenile Idiopathic Arthritis is one subtype of JIA,the incidence of SoJIA is about 10% of the total incidence of JIA, but not its mortality and morbidity. SoJIAs have no characteristic clinical manifestations, Its diagnosis is mainly on the systemic symptoms. According to the American College of Rheumatology Pedi（ACR） JIA treatment guidelines, being diagnosed as SoJIA needs to be under 16 years old, and the patients’ total duration is more than 6 weeks,whose main performance is prolonged fever and joint manifestations. SoJIAs always have an everyday fever for more than 2 weeks, or at least an everyday fever for more than 3 days, with more than one performance below: a rash（which offen appears at trunk, axilla,and may worsen with the fever）, a wide range of lymph node enlargement, hepatosplenomegaly or other systemic performance. At the same time the diagnosis needs the exclusion of sepsis, malignant tumor, infectious diseases. So far the treatment for SoJIA aims to control the symptoms, achieve disease remission and avoid serious complications by early combined and systemic treatment. Macrophage activation syndrome（MAS）, heart disease and other serious complications may occur in SoJIA. To control its serious systemic symptoms and complications, glucocorticoid（GC） is always seen as the preferred applications and usually used for a long time. As all known that long-term treatment of GC would result in osteoporosis, growth restriction, vertebral compression fractures, femoral head necrosis and other complications. Also it may interference the metabolism of vitamin D, there had been researches on the correlationship between GC and vitamin D metabolism all over the world, but no final conclusion has yet been reached on this matter. It is well known that vitamin D plays an important role in the bone formation process, and it may also participate in the immune response and be associated with a variety of immune disorders related disease processing. Therefore, the serum 25（OH） D₃ levels in SoJIA children who need to take long-term GC should be monitored, so we can give reasonable complement of vitamin D₃ to decrease the complications due to taking long-term GC.Objective: We detected the serum 25（OH） D₃ levels in SoJIA children before the glucocorticoid treatment,4 weeks later and 8 weeks later respectively. Then we compared the changes of the serum 25（OH） D₃ levels and discussed the influence which glucocorticoid had made on the serum 25（OH） D₃ level. 4 weeks later we compared the serum 25（OH） D₃ between the remission group and non-remission, then we explored the relationship between the disease remission degree and the serum 25（OH） D₃ levels. Finally we gave some suggestions to SoJIAs who need to take long-term GC about how to reduce the complications by taking vitamin D₃ reasonably.Method: We collected the clinical datas of 20 SoJIA inpatients in China-Japan union hospital from January 2012 to August 2015. All of the patients need to be treated with GC according to ACR Pedi JIA treatment guidelines, and before the treatment we gave them a supplement of vitamin D₃（800 IU/D） and calcium（1000 mg/D） for prevention [3].We detected the serum 25（OH） D₃ levels before they taking GC, 4 weeks later and 8 weeks later respectively. then we compared the levels. After 4 weeks’ treatment of GC we evaluated the degree of disease remission with the ACR 30 criterion, and divided the children into 2 groups: the ACR pedi 30 remission and the non-remission. Then we compared the serum 25（OH） D₃ levels of different patients in two groups and measured the results into statistics processing.Result: The serum 25（OH） D₃ levels in SoJIA children was 50.76± 14.85 nmol/l, the patients with severe vitamin D deficiency accounted for 5%; After 4 weeks’ treatment of GC, the serum 25（OH） D₃ levels decreased to 43.59 ±13.70 nmol/l, and the severe deficiency percentage increased to 10%,compared with the serum 25（OH） D₃ levels before the application of GC, P < 0.05,that’s mean the result was statistically significant. 8 weeks later, the serum 25（OH） D₃ levels was 34.11±10.78 nmol/l, and the severe deficiency proportion was 40%, compared with the serum 25（OH） D₃ levels 4 weeks before, p < 0.05, and the result was statistically significant. In the study of the relationship between disease remission and serum 25（OH） D₃, we found that 4 weeks later we had 11 remittent children and the serum 25（OH） D₃ was 45.45±14.28nmol/l, 9 childen was not remittent and the serum 25（OH） D₃ was 41.30±13.42nmol/l.But the statistical processing showed that P>0.05. That means that there was no significant difference in the serum 25（OH） D₃ levels between the two groups. The result has no statistical significance.Conclusion :The mean level of 25（OH） D₃ in SoJIA children is lower than those in normal children. With the using of GC, the level of 25（OH） D₃ decreased gradually. At the same time, the serum 25（OH） D₃ level had no relationship with the degree of the disease remission. In conclusion for the patients who need long-term GC should be monitored the serum 25（OH） D₃ level, and according to the degree of vitamin D₃ deficiency,reasonable complement of vitamin D₃ should be given.