Changes in the nutritional status in children with rheumatic diseases on the background of glucocorticosteroid therapy

Introduction. With the continuous aggressive course of rheumatic disease and the presence of side effects of treatment with glucocorticosteroids (GCS), patients children are at high risk of developing disorders of nutritional status.
The aim of the work: to determine the changes in the nutritional status of children with rheumatic diseases against the background of therapy with GCS.
Materials and methods. 113 children aged 3 to 18 years with a confirmed diagnosis of a rheumatic disease (systemic lupus erythematosus, juvenile arthritis with systemic onset, juvenile dermatomyositis, systemic vasculitis) who received oral corticosteroid therapy at a daily dose of at least 0.15 mg/kg in terms of prednisolone for at least 3 months were examined. The analysis of clinical and anamnestic data and the course of the main disease was carried out, and anthropometric indices were calculated: Z-scores of body weight/age, height/age, and BMI/age using the Anthro and AnthroPlus programs. The data obtained were interpreted according to the WHO classification of nutritional disorders.
Results. Adequate indicators in the structure of the nutritional status of children with rheumatic diseases were established in less than half (n = 48; 42.5%) of patients. Excess body weight/obesity and malnutrition were detected in almost the same percentage of cases (28.3 and 29.2%, respectively). Children with systemic juvenile arthritis and juvenile dermatomyositis were predominantly overweight and obese (40% and 40.9%, respectively). Regardless of the nosological form of rheumatic pathology, malnutrition was observed in 25.5–32.2% of cases. At the same time, a significant inverse moderate correlation (rxy = –0.510; p < 0.001) was found between the duration of GCS use and the Z-score for height/age. The use of GCS therapy in the treatment of rheumatic diseases in children led to the development of severe complications such as drug-induced Cushing’s syndrome, steroid-induced osteoporosis and osteopenia, compression fractures of vertebral bodies, and aseptic bone necrosis. Steroid cataracts and musculoskeletal disorders were detected with equal frequency. Erosive-ulcerative lesions of the gastrointestinal tract were diagnosed somewhat less frequently.
Conclusion. The use of GCS improves the prognosis of rheumatic diseases in children. Timely diagnosis of metabolic disorders, pathology of the musculoskeletal and digestive systems, assessment of nutritional status in children with rheumatic diseases against the background of GCS therapy, and adequate correction of the identified disorders through the optimization of therapeutic diets will have a positive effect on the course and prognosis of rheumatic disease in children.

children, rheumatic diseases, systemic lupus erythematosus, juvenile arthritis, juvenile dermatomyositis, systemic vasculitis, glucocorticosteroids, nutritional status, overweight, obesity, malnutrition

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