2024-03-11 19:54:15
Aysor.am continues the series of publications dedicated to Juvenile Idiopathic Arthritis. By following this series, you will get to know the causes of this disease, symptoms, different forms of manifestation, types of the disease, features of treatment and care.
In recent years, new prospects for the treatment of Juvenile Idiopathic Arthritis have been opened thanks to the newest drugs. They are known as biological drugs because they are obtained through biological engineering. Unlike “Methotrexate” and “Leflunomide”, which affect all rapidly dividing cells, these drugs are mainly directed against specific molecules, that is, they have a more targeted effect and do not harm healthy cells of the body, hence causing less biased effects.
Juvenile idiopathic arthritis treatment for confirmation received and: widely applicable first biological from drugs one “Tocilizumab” iswhich is approved in the treatment of both systemic and polyarticular forms of juvenile arthritis.
Tocilizumab is a monoclonal antibody that is structurally similar to the interleukin 6 (IL6) protein molecule. It selectively binds to interleukin 6 protein molecule receptors and blocks the inflammatory effect of interleukin 6 in various tissues, especially joints. Thus, “Tocilizumab” suppresses the inflammatory process by its effect. It is used mainly as a monotherapy, but it can also be combined with basic drugs if the doctor deems it appropriate. Tocilizumab is given intravenously and is given in a hospital setting every 4 weeks. As a rule, “Tocilizumab” injections pass without complications, the general tolerability of the drug is quite good, which is due to the presence of a mostly human component (humanized antibody) in the protein molecule. Monitoring of liver enzymes, monitoring of the number of white blood cells (neutrophils) or platelets, monitoring of the amount of fat in the blood is very important to evaluate side effects. Tocilizumab is approved for the treatment of patients with corticosteroid-dependent Systemic Juvenile Idiopathic Arthritis as well as polyarticular Juvenile Idiopathic Arthritis who do not respond to other drugs such as Methotrexate.
A separate class of biologic drugs used in the treatment of juvenile arthritis is the tumor-destroying factor inhibitors, TNF-blockers, which inhibit or prevent the binding of TNF to its receptor, thus inhibiting or attenuating the inflammatory process that underlies Juvenile Idiopathic Arthritis.
This to the group is belong to «Etanercept», which is prescribed in the form of subcutaneous injections, which can also be done at home by the patient or relatives. Side effects may include local reactions (redness, itching, swelling) at the injection site, but they are usually short-lived and mild. “Etanercept” is indicated in the main pediatric rheumatic diseases in the polyarticular form of Juvenile Idiopathic Arthritis in children who do not respond to other drugs, for example, “Methotrexate”. It is also used (without clear evidence) to treat uveitis associated with IIA when methotrexate and topical steroid treatment are ineffective. But among the local side effects, there may also be changes caused by the general organism, in connection with which the patient should be under constant supervision by the primary treating physician.
TNF-besiegers to the group belonging to next the drugInfliximab is” which is a chimeric (part of the drug is taken from a mouse protein) monoclonal antibody. Monoclonal antibodies bind to TNF, thus inhibiting or reducing the inflammatory process. Infliximab is given as an intravenous injection, usually every 8 weeks, and is combined with methotrexate to reduce side effects. Among the side effects, especially during the injection, allergic reactions of varying severity (difficulty breathing, red rash on the skin, itching) can occur, which are easily treated, or severe allergic reactions (drop in blood pressure) and the risk of shock. The occurrence of these allergic reactions is more likely after the first injection and is due to the formation of antibodies against the drug molecules. Those molecules are obtained from mice, in fact, the body develops immunity to them. It is used in children’s rheumatic diseases. Infliximab is not approved for Juvenile Idiopathic Arthritis and is used off-label (ie, there is no indication on the drug label for use in JIA).
Next “Adalimumab” is: human monoclonal antibody. It is prescribed in the form of subcutaneous injections once every 2 weeks, usually combined with “Methotrexate”. Side effects may include local reactions (redness, itching, swelling) at the injection site, but they are usually short-lived and mild. Indicated for the polyarticular form of Juvenile Idiopathic Arthritis in children who do not respond to other drugs such as Methotrexate. It is used (without well-proven indications) to treat uveitis associated with IIA when methotrexate and topical steroid treatment are ineffective.
Because experience with TNF-blockers is still new, no real long-term safety data are currently available.
Other: nature effect having biological from drugs are “Anakinran.” which is a recombinant version of the natural protein molecule (IL-1 receptor antagonist). It affects IL-1 by inhibiting the inflammatory process, particularly in Systemic Juvenile Idiopathic Arthritis and autoinflammatory syndromes such as Cryopyrin Associated Syndrome (CAPS) starting at 2 years of age. It is often used off-label (ie, not indicated) in patients with corticosteroid-dependent juvenile idiopathic arthritis and certain other autoinflammatory diseases.
Canakinumab is a second-generation monoclonal antibody specific to a protein molecule called interleukin 1 (IL1), which significantly suppresses the inflammatory process, particularly in Systemic Juvenile Idiopathic Arthritis and certain autoinflammatory diseases, such as Cryopyrin-Associated Syndrome (CAPS).
In general, all biologic drugs carry a high risk of developing infections. Therefore, it is important to insist that the patient/parent be informed and take preventive measures such as vaccinations (knowing that live attenuated vaccines are recommended only before starting treatment, while other vaccinations can be given during treatment). Tuberculosis screening (tuberculosis skin test or PPD) is also mandatory for those who are going to receive treatment with biologic drugs, as these patients are particularly susceptible to TB. Usually, if a patient develops an infectious process, the treatment with biological drugs is stopped immediately, but the discontinuation should be discussed in advance with the treating doctor for each specific case.
Follow our publications and get acquainted with the drugs used in the treatment of Juvenile Arthritis, as well as rehabilitation measures.
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