BASIC FIBROBLAST GROWTH FACTOR AND ADIPONECTIN IN ADOLESCENCE WITH JUVENILE IDIOPATHIC ARTHRITIS TREATED WITH METHOTREXATE

Liudmyla Parkhomenko,Olga Pavlova,Larysa Strashok

doi:10.21303/2504-5679.2020.001372

Liudmyla Parkhomenko, Olga Pavlova + Show 1 more

Open Access

https://doi.org/10.21303/2504-5679.2020.001372

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Abstract

Methotrexate has been applied clinically for juvenile idiopathic arthritis (JIA) treatment for decades. It is recommended for use globally, according all modern guidelines. Despite the fact that fibrosis molecular mechanisms as well as methotrexate (MTX) elimination and fibrosis indexes were studied a lot there is still not enough information for adolescence. Adiponectin, fibroblast growth factor and fibrosis indexes in adolescents with JIA treated with methotrexate were studied in this work. The aim was to study dynamics of molecular-cellular mechanisms activation of fibrotic processes development in the liver in adolescents with juvenile idiopathic arthritis treated with methotrexate. Materials and methods: A total of 68 children with juvenile idiopathic arthritis, were enrolled in the study. 25 boys (36.8 %) and 43 girls (63.2 %) were examined. Children were divided into three groups in accordance with the methotrexate dose. The following data were analyzed: ESR (mm/hour), C-reactive protein (mg/l), Hemolytic activity (CU), circulating immune complexes, (g/l), ALT (U/l), AST (U/l), Adiponectin (mcg/ml), BFGF (pg/ml), APRI index, FIB-4 Score. Results: According to our results when patients start using MTX they have significantly positive effect. Therefore, when analyzing all parameters liver pathologies may occur before MTX use. When MTX used, its proinflammation and antifibrotic effects lead to normalization of all organs and systems, as well as joints and liver. Also, long-term MTX use can lead to adverse effects. Conclusions: So, it is important to control possible liver disorders in adolescence treated with MTX. According to our study results we find out that there are decreasing of liver damage parameters in patients which started using MTX.

Highlights

Juvenile idiopathic arthritis (JIA) is the most common chronic disease of childhood
1,000 children is affected by the various subtypes of JIA
MTX is subject to first-pass metabolism in the liver and is converted to 7-hydroxymethotrexate, which is a major metabolite of MTX [6]

Summary

Introduction

Juvenile idiopathic arthritis (JIA) is the most common chronic disease of childhood. One in1,000 children is affected by the various subtypes of JIA. Methotrexate (MTX) is a cornerstone of therapy worldwide for JIA, yet there remains vast variability in drug dosing and administration, as well as unpredictable outcomes on the drug [1]. MTX maximum plasma concentrations are between 0,3 and 1,6 μmol/L, and occur at up to two hours after administration [3]. Adding folic or folinic acid to therapy almost eliminates such side effects as nausea, vomiting, diarrhea, or stomatitis [3]. Manifestations of nausea and diarrhea are more often observed with oral administration of MTX [5]. Major elimination route of MTX is renal excretion constitutes. The plasma half-life of low dose MTX varies from 4.5 hours to 10 hours [4]. Hepatotoxicity is one of the main side effects of MTX in the JIA treatment. Slight increase in aminotransferases level, less commonly hepatic steatosis, fibrosis and cirrhosis are most common manifestations [8]

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