Does growth hormone therapy improve arthritis?

Growth Hormone Does Not Improve Arthritis

Growth hormone therapy is not recommended for the treatment of arthritis as there is no evidence supporting its efficacy for improving arthritis symptoms or disease progression. 1

Evidence Assessment

Growth Hormone in Arthritis Management

The European League Against Rheumatism (EULAR) guidelines for fibromyalgia management specifically evaluated growth hormone therapy and found:

• While growth hormone showed some effect on pain in limited studies (effect size 1.36), there were significant safety concerns including sleep apnea and carpal tunnel syndrome 1
• The EULAR committee issued a "strong against" recommendation (94% agreement) for using growth hormone in fibromyalgia management 1

For rheumatoid arthritis and other inflammatory arthritides:

• None of the major treatment guidelines for rheumatoid arthritis or osteoarthritis recommend growth hormone as a treatment option 1
• Current guidelines focus on conventional synthetic DMARDs (particularly methotrexate), biologics, NSAIDs, and glucocorticoids as the mainstays of therapy 1

Growth Hormone in Specific Populations

Growth hormone has been studied in children with juvenile idiopathic arthritis (JIA) who experience growth failure, but not as a treatment for the arthritis itself:

• Studies show that growth hormone can improve height in children with JIA who have growth retardation, particularly those receiving glucocorticoid therapy 2, 3, 4
• A randomized controlled study demonstrated that growth hormone treatment increased final height in JIA patients (mean increment of 1.6 SD in treated group vs. loss of 0.7 SD in control group) 4
• However, these studies did not show consistent improvement in arthritis symptoms or disease activity 5, 2

Treatment Approach for Arthritis

For osteoarthritis (glenohumeral/shoulder):

• Physical therapy and pharmacotherapy are first-line treatments 1
• Injectable options include corticosteroids (though evidence is limited) and viscosupplementation 1
• Surgical options for advanced disease include total shoulder arthroplasty or hemiarthroplasty 1

For rheumatoid arthritis:

• Early use of DMARDs, particularly methotrexate as an anchor drug 1
• Glucocorticoids at the lowest effective dose for the shortest time possible (<6 months) as adjunctive treatment 1
• NSAIDs for symptomatic relief with careful consideration of cardiovascular, renal, and gastrointestinal risks 1

Common Pitfalls and Caveats

1. Confusing growth improvement with arthritis improvement: While growth hormone may improve height in children with JIA, this should not be confused with improvement in the arthritis itself 5, 2, 4

2. Overlooking side effects: Growth hormone therapy carries risks including glucose intolerance, diabetes, bone deformities, and potential disease reactivation 2

3. Inappropriate use in adults: There is even less evidence supporting growth hormone use in adult arthritis patients, and the EULAR guidelines specifically recommend against it in fibromyalgia 1

4. Focusing on growth hormone while delaying proven therapies: Delaying established treatments like DMARDs, NSAIDs, or appropriate glucocorticoid therapy while pursuing growth hormone could lead to worse outcomes and disease progression

In conclusion, while growth hormone may have specific applications in managing growth failure in children with JIA, it should not be used as a treatment for arthritis itself in either children or adults.