Child climbing a ladder of building blocks towards a star, symbolizing growth with biologic therapy.

Battling Growth Inhibition: How Biologic Therapies Help Kids with Chronic Inflammatory Diseases

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Elliot Brynn in Health & Wellness October 2026 • 4 min read.

"Discover how biologic treatments can combat growth problems in children with chronic inflammatory conditions, offering hope for improved development and well-being."


Chronic inflammatory conditions, like juvenile idiopathic arthritis (JIA), present numerous challenges for children. One of the most concerning complications is the inhibition of growth velocity. Inflammation within the musculoskeletal system and the use of glucocorticoid therapy can significantly impact a child's growth, making it crucial to find effective treatments that address both the disease and its impact on development.

Traditionally, treatments have focused on managing inflammation, often relying on corticosteroids to reduce disease activity. While these medications can be effective, they also come with significant side effects, including further growth suppression. This creates a difficult balancing act: controlling the disease while minimizing harm to the child's growth and overall well-being.

In recent years, biologic therapies have emerged as a promising approach. These medications target specific components of the immune system, offering a more precise way to manage inflammation with potentially fewer side effects. This article will delve into how biologic therapies are influencing growth patterns in children with chronic inflammatory connective tissue diseases, providing insights into the potential for these treatments to restore normal development.

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Biologics and Growth in Pediatric Rheumatic Disease

Juvenile idiopathic arthritis (JIA), childhood-onset systemic lupus erythematosus (cSLE), and juvenile dermatomyositis (JDM) are among the most common pediatric rheumatic diseases, for which cures are generally unavailable. The 2025 systematic review examined growth outcomes in children with JIA receiving biologic therapy, analyzing 12 studies published from 2003 to 2018 and encompassing 1,513 patients with a mean age of 11.4 years. A 2015 review reports that effective biological therapy can improve disease activity and reduce glucocorticosteroid doses, gradually accelerating and normalizing growth in children with chronic inflammatory connective tissue diseases. Etanercept was the first biologic approved to treat JIA, in 1999.

Assessing Growth Around Biologic Treatment

Research on growth in JIA has compared growth velocity before and after biologic treatment begins, including the onset of therapy in relation to severe disease and inflammation. A cited study is the British Society for Paediatric and Adolescent Rheumatology Etanercept Cohort Study, which examined growth over two years of etanercept treatment. Another study describes comparing growth velocity before and after therapy while considering JIA subtype, steroid use, and the requirement for one or more treatments. The supplied source excerpts identify these approaches but do not provide results or establish their limitations.

A New Era in Pediatric Rheumatology

Biologic drugs are synthesized within biological systems and designed to target specific molecules involved in cytokine signaling or interactions between cells. A 2014 review describes the preceding 15 years as a revolution in effective treatments for rheumatic diseases, particularly JIA. Pediatric rheumatology itself has grown from a small emerging specialty into a field advancing research, clinical care, and advocacy over its 50-year history.

How Do Biologic Therapies Restore Growth in Children with CTD?

Child climbing a ladder of building blocks towards a star, symbolizing growth with biologic therapy.

Biologic therapies represent a significant advancement in treating chronic inflammatory conditions in children. Unlike traditional treatments that broadly suppress the immune system, biologics target specific molecules, such as tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), which are key drivers of inflammation. By selectively blocking these molecules, biologics can effectively reduce inflammation with potentially fewer widespread side effects.

The benefits of biologic therapies extend beyond just managing inflammation; they also have a positive impact on growth. The connection between inflammation, steroid use, and growth inhibition is complex, but it's clear that reducing inflammation and minimizing steroid exposure are essential for restoring normal growth velocity. Here’s how biologic therapies achieve this:

  • Directly Inhibiting Inflammation: Biologics reduce inflammation within the musculoskeletal system, mitigating its direct impact on growth plates and hormone production.
  • Reducing Reliance on Glucocorticoids: By effectively controlling inflammation, biologics allow doctors to lower the doses of glucocorticoids (GCS), or even eliminate them entirely. This reduces the harmful effects of steroids on growth.
  • Normalizing Hormone Levels: Chronic inflammation can disrupt the secretion of growth hormone (GH) and insulin-like growth factor (IGF), both crucial for growth. Biologics help restore a more balanced hormonal environment.
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Growth Responses Are Not Uniform

Growth improvement with biologic treatment is not assured for every child. In some studies, patients with systemic JIA had significantly smaller changes in growth parameters during biologic treatment than other patients. A study of children treated with etanercept reported that the lack of a strong association between improved height and improved disease activity warrants further exploration. Biologic agents can also cause adverse events with long-term use, according to a review of safety in pediatric rheumatology.

Growth Findings Across Biologic Treatments

A study of etanercept in JIA reported that growth velocity rose from 3.7 ± 1.2 cm before treatment to 7.6 ± 1.2 cm in the first treatment year (p < 0.001). In children with systemic JIA receiving long-term corticosteroid therapy, a tocilizumab study found that the change in height velocity standard deviation score (HVSDS) improved from −6.0 ± 4.0 in the year before baseline to −2.5 ± 3.9 in the year after baseline (p = 0.0064). Another tocilizumab study reported a mean height SDS of −2.27 ± 1.85 and height velocity SDS of 2.51 ± 1.98 after one year (p < 0.001). These findings come from different studies and populations, so the supplied material does not establish a direct comparison between the therapies.

A study published in Reumatologia examined the impact of biologic therapy on growth in children with chronic inflammatory connective tissue diseases (CTD). The researchers reviewed data from 24 patients treated with TNF-α blockers and an IL-6 receptor blocker. They found that growth velocity accelerated in 70.1% of patients during biologic treatment, with a mean height-SDS improvement of 0.51 ±0.58 between the start of treatment and two years later. Notably, 47% of patients were able to reduce their daily doses of GCS to 0 mg/kg/day.

The Future of Growth in Pediatric CTD

Biologic therapies offer a promising path forward for children with chronic inflammatory diseases who struggle with growth inhibition. By targeting inflammation and reducing reliance on steroids, these treatments can help restore normal growth velocity and improve overall development. As research continues and new therapies emerge, the outlook for children with CTD becomes increasingly hopeful, ensuring they have the opportunity to reach their full potential.

Growth changes in relation to baseline

  • 39% of patientsIn the Childhood Arthritis Prospective Study, 39% of children with JIA experienced growth restriction over the first three years of disease, defined as a change in height standard deviation score below 0.5.[1]

What growth measurements capture

Normalization of growth velocity and recovery of an existing height delay are different outcomes: the reported normalization did not mean that the delay was corrected.[2]

The reported link between etanercept-related growth effects and reduced systemic IL-6 offers a possible biological connection, but it does not by itself establish that the IL-6 reduction caused the growth change.[1]

The evidence describes different routes by which inflammatory signals may affect growth: TNFα and IL1β influence cartilage-cell dynamics directly, while IL6 acts through systemic mechanisms.[3]

How the growth reports compare

The anti-TNF-α result was reported for a group that included children with JIA, but the report did not find significant efficacy in those with severe disease. That qualification matters when comparing its average result with outcomes in other patient groups.[4]

The source calls for randomized controlled trials to use consistent inclusion criteria and growth measures, while accounting for disease severity and prior treatment. This identifies differences in study design that can complicate comparisons across reports.[1]

A higher proportion of children with systemic and severe polyarticular JIA was proposed as one possible reason for disagreement with earlier anti-TNF growth-restoration reports. This points to patient mix as a potential influence on cross-study differences.[2]

What remains unresolved about growth response

  • Would growth velocity and height delay show the same pattern when assessed separately, given that velocity could normalize without correction of delay?[2]
  • How much of the observed variation between reports reflects disease severity and patient mix, rather than differences in treatment or measurement?[1] [2]

Sources

  1. Effect of biologic treatments on growth in children with juvenile idiopathic arthritis: A systematic review (pmc.ncbi.nlm.nih.gov)
  2. Impact of biologics on growth in children with juvenile idiopathic arthritis (pmc.ncbi.nlm.nih.gov)
  3. Algorithm for Growth Evaluation in Juvenile Idiopathic Arthritis (pmc.ncbi.nlm.nih.gov)
  4. Growth and puberty in children with juvenile idiopathic arthritis (pmc.ncbi.nlm.nih.gov)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

Everything You Need To Know

1

What exactly are biologic therapies and how do they work?

Biologic therapies are a class of medications that target specific components of the immune system, such as tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). Unlike traditional treatments that broadly suppress the immune system, biologics selectively block these molecules that drive inflammation. This targeted approach aims to reduce inflammation with potentially fewer widespread side effects, making it particularly valuable for children with chronic inflammatory conditions.

2

What is growth velocity, and why is it so important for children with chronic inflammatory diseases?

Growth velocity is the rate at which a child grows over time. In children with chronic inflammatory diseases, inflammation and treatments like glucocorticoids can inhibit growth velocity, leading to stunted growth. Restoring growth velocity is important because it allows children to reach their full height potential and supports overall healthy development. Biologic therapies are significant as they aim to restore a normal growth rate by reducing inflammation and minimizing the use of steroids.

3

What are glucocorticoids and why is reducing reliance on them important in treating children with chronic inflammatory diseases?

Glucocorticoids, also known as steroids, are medications used to reduce inflammation. While effective in managing inflammation, they can have significant side effects, including growth suppression in children. The reliance on glucocorticoids creates a difficult balancing act, as controlling the disease is essential, but minimizing the harm to a child's growth is equally important. Biologic therapies play a role in reducing or eliminating the need for glucocorticoids, thereby lessening the negative impact on growth.

4

What are TNF-α and IL-6, and why are they important targets for biologic therapies?

Tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) are specific molecules, also known as cytokines, that play a key role in driving inflammation in chronic inflammatory conditions. By selectively blocking these molecules, biologics can effectively reduce inflammation with potentially fewer widespread side effects. TNF-α and IL-6 are targeted because of their significant contribution to the inflammatory process, making them key targets for therapeutic intervention in conditions like juvenile idiopathic arthritis (JIA).

5

What are chronic inflammatory connective tissue diseases (CTD), and how do biologic therapies help children affected by these conditions?

Chronic inflammatory connective tissue diseases (CTD) are a group of conditions, such as juvenile idiopathic arthritis (JIA), characterized by long-term inflammation that affects various tissues and organs. These conditions can significantly impact a child's growth and development. Biologic therapies are offering hope for improved outcomes by targeting the underlying inflammation and reducing the need for steroids, which can further inhibit growth. By addressing the root causes and consequences of inflammation, these therapies aim to restore normal growth velocity and improve overall well-being in children with CTD.

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