2024-02-29 14:44:17
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.
A group of drugs widely used in the treatment of juvenile idiopathic arthritis are called basic drugs, or main drugs, or drugs affecting the course of the disease. Unlike symptomatic drugs, this group makes it possible to prevent the development of the general disease, sometimes to have a stable long-term remission with the development of the disease.
The most frequently used of these drugs is “Methotrexate”.
“Methotrexate” began to be used in pediatric practice many years ago for the treatment of various diseases. It was originally developed as an anti-cancer drug because of its ability to slow cell division (proliferation). This effect is significant only at high doses. When used in low doses, as it is done in the treatment of rheumatic diseases, the mechanisms of the anti-inflammatory effect of “Methotrexate” are different. When used in such small doses, most of the side effects typical of higher doses either do not occur or are much milder and easier to manage.
Methotrexate comes in two forms: tablets and solution for injection. It is taken once a week, always on the same day of the week. The appointment of folic acid 24 hours after taking “Methotrexate” reduces the likelihood of developing some side effects. The form of introduction and dosage is determined by the doctor depending on the condition of the child. Tablets are better absorbed if taken before meals, usually with water. Injections are given subcutaneously, like insulin injections in diabetes, but can also be given intramuscularly or, very rarely, intravenously. The advantage of injections is that the absorption of the drug is better and gastric irritation occurs less often.
Treatment is long-term. Many experts recommend continuing to take the drug after the disease has gone into remission, at least for another 6-12 months.
As a rule, side effects rarely develop in children treated with “Methotrexate”. they are nausea, vomiting and abdominal pain. Their occurrence can be alleviated by taking the medicine in the evening before going to bed. By taking a vitamin called folic acid at the same time, it is possible to prevent these side effects from occurring. Sometimes it is effective to take an anti-emetic before and after taking methotrexate, or to alternate taking pills with an injection. Other side effects may include ulcers on the oral mucosa or, more rarely, a skin rash.
Cough and breathing problems are rare side effects in children. The decrease in blood cell count is usually minor. Long-term liver damage (liver fibrosis) is extremely rare in children because other hepatotoxic (harmful factors affecting the liver) such as alcohol abuse are absent in children. Methotrexate is usually stopped temporarily if there is an increase in the level of liver enzymes in the blood and resumed when they return to normal. Regular blood tests are required during treatment with Methotrexate. The risk of infection in children is not particularly high.
Important problems can arise when a child becomes a teenager. It is necessary to strictly avoid the intake of alcohol, because the latter can increase the harmful effect of “Methotrexate” on the liver. “Methotrexate” can have a harmful effect on the fetus, so it is necessary to maintain the use of contraceptives when a person reaches childbearing age.
Methotrexate is indicated in the main pediatric rheumatic diseases: Juvenile Idiopathic Arthritis. Juvenile Dermatomyositis, Juvenile Systemic Lupus Erythematosus, Focal Scleroderma.
The next drug that is used in basic treatment is “Leflunomide”.
“Leflunomide” is an alternative option for patients with intolerance to “Methotrexate”. However, experience with this drug for childhood arthritis is small, and it has not been approved by regulatory authorities.
“Leflunomide” is prescribed in the form of tablets. The appointment of these and all similar drugs and the selection of the dosage is made only by the relevant specialist, as the prescription of the drug can be changed by the specified specialist. The prescription of basic drugs for the treatment of juvenile arthritis cannot be made or changed by an arbitrary doctor, because such interventions can lead to an exacerbation of the disease and a sharp deterioration of the child’s condition.
Because leflunomide is considered a highly teratogenic drug (can cause developmental defects in the fetus), female patients should have a negative pregnancy test before starting this treatment and use appropriate contraception. Side effects include diarrhea, nausea, vomiting. In case of toxic effects, treatment with appropriate drugs is indicated under the supervision of a doctor. “Leflunamide” is used in children’s rheumatic diseases, in particular, in Juvenile Idiopathic Arthritis, although it does not have an established indication.
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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