Fibroblast growth factor and hepatocyte growth factor in adolescents with juvenile idiopathic arthritis treated with methotrexate

Olga Pavlova

doi:10.15587/2519-4798.2020.213126

Abstract

Methotrexate (MTX) is a cornerstone of therapy worldwide for juvenile idiopathic arthritis (JIA). Despite the fact that fibrosis molecular mechanisms as well as MTX elimination and fibrosis indexes were studied a lot there is still not enough information for adolescence.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 by determining the content of fibroblast growth factor and hepatocyte growth factor.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 four groups in accordance with cumulative dose (CD) of methotrexate. The following data were analyzed: liver function tests (aspartate aminotransferase (AST) (U/L), alanylaminotransferase (ALT) (U/L)), lactate dehydrogenase (LDH) (U/L), adiponectin (μg / ml), BFGF (pg / ml), HGF (pg / ml), liver fibrosis indexes APRI and FIB-4 Score.Results. Positive effect of JIA treatment with MTX on the liver is noted. When CD MTX reaches 1 and3 grams, liver state studying is needed. When the CD MTX of1 gram is reached, regulatory mechanisms are involved that provoke liver regeneration. When the CD MTX reaches3 grams, the liver condition may deteriorate, which in the future can lead to irreversible processes of liver fibrosis.Conclusions: Thus, it is important to control possible liver disorders in adolescence treated with MTX. Monitoring the processes of liver fibrosis is appropriate at all stages of JIA treatment, but it is most advisable when the MTX cumulative dose is reaching 1 and3 grams

Highlights

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood (1:1000 children)
Materials and methods A prospective controlled study was conducted in 68 adolescents who in 2017–2019 were treated in the Department of Cardiorheumatology of the State Institution “Institute of Child and Adolescent Health of the National Academy of Medical Sciences of Ukraine” with a diagnosis of “Juvenile Idiopathic Arthritis” (UA, ICD-X M08 according to the International Classification of Diseases 10th revision)
Pain, and tenderness on palpation in the right hypochondrium were observed in 40 % of adolescents with juvenile idiopathic arthritis (JIA) treated with methotrexate

Summary

Introduction

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood (1:1000 children). Methotrexate (MTX) remains the drug of choice for JIA treatment, despite the development and active implementation of immunobiological therapy [1]. Hepatotoxicity remains one of the most common side effects of MTX. Slight increase in aminotransferases level, hepatic steatosis, fibrosis and cirrhosis are most common manifestations of hepatotoxicity [4], which reflect the morphological features of non-alcoholic fatty liver disease (NAFLD). On its basis, mechanisms of neutralization and excretion of a substance foreign to it were formed. All this ensured the effective functioning and reproduction of organisms and their adaptation to the changing conditions of existence due to fluctuations in climate and other factors, the

Methods

Results

Conclusion