In Russia, innovative drugs will be used to combat rheumatoid arthritis in children. Now they are ill over 20 thousand if the disease is not treated, it can destroy the joints, lead to blindness and impress almost all organs. At the same time, drugs suitable for therapy of the most severe version of juvenile arthritis – systemic – are less than for the treatment of the rest.
About this on the eve of the day of dissemination of information about rheumatoid arthritis, which is celebrated on February 2, Aif.ru told Director of the Clinical Institute of Children’s Health named after Filatov, chief freelance children’s specialist rheumatologist of the Ministry of Health of Russia, corresponding member of the Russian Academy of Sciences Ekaterina Alekseeva.
Patients are getting younger
– Ekaterina Iosifovna, what is the peculiarity of juvenile arthritis?
– Juvenile arthritis is a genetically determined disease, that is, patients have breakdowns in genes regulating the functioning of the immune system. As a result, it recognizes the cells of the body as enemies. Therefore, the treatment is aimed at stopping the fighting of the immune system against its own body.
In total, children have seven options for juvenile arthritis. Most often, it affects the joints – swelling, pain, morning stiffness occurs. If a large number of joints are affected, the child may lose the ability to move. There is an arthritis option that affects the vascular shell of the eye, which can lead to a decrease in visual acuity and blindness – it is called uveit. Some species can lead to a cytokine storm, when a huge amount of pro -inflammatory proteins has a toxic effect on almost all organs and tissues, which threatens life.
Children of all ages are sick. Now we observe the “rejuvenation” of the disease – we are increasingly accepting the kids who are ill in the first, second year of life.
– Is it possible to cure him?
– Literally a couple of decades ago, most children were doomed to disability – the disease destroyed their joints and other organs. To understand what we are talking about, you can look at the late portraits Auguste Renoir – His hands were erase with rheumatoid arthritis, and when he painted his last paintings, the brush had to be tied, since his fingers did not work. And it was extremely difficult to stop the disease not only in the XIX, but also in the XX century.
When about 25 years ago I came to work as a doctor, in our arsenal there were only methotrexate – a drug that suppresses the hyperactivity of the immune system – and injections of corticosteroid hormones into the joints. This was not always effective. It was especially difficult to fight systemic arthritis – the most severe type of disease. Often in patients, secondary amyloidosis developed. This is a severe complication, in which, due to inflammatory activity, pathogenic amyloid protein accumulates in the kidneys, liver, intestines, brain, the heart, gradually displaces normal cells, as a result of which multiple organ failure develops and a person dies. The disease could only be suppressed by very high doses of corticosteroids, which, in turn, also led to complications. Including a delay in growth-the teenager could have been 15-16 years old, and his height remained 105 centimeters.
“The child was able to get up for the first time”
– What has changed since then?
-In the early 2000s, a revolution occurred in rheumatology-in Russia the era of targeted therapy began. Scientists have revealed, one might say, perpetrators of children and adults in the body with juvenile and rheumatoid arthritis. They turned out to be cytokines – pro -inflammatory proteins, which are responsible for the excessive activity of the immune system. And against them, drugs that affect these proteins were synthesized.
In 2002, we first used an innovative genetically engineer biological drug-infliximab. It was incredible. I remember that the patient’s mother was sitting in the corridor and cried – her child could not stand up, all the swollen lay, her eyes were watery, he could not look at the light, because both joints and eyes were amazed. And the next morning, after the introduction of the drug, he was able to get out of bed, and he did not even have constraint in movements. Now the patients, whom we treated the first to genetically engineering drugs, are already adults. Some of them study at the Pediatric Faculty of Sechenov University.
Since then, a number of drugs have been created that affect various targets, since each type of juvenile arthritis has its own development mechanism.
The most advanced
– What are the latest drugs?
– Now there is a study of a new drug – Olokizumab. This is not an analogue of some existing drug, but a completely new molecule-a monoclonal antibody to the pro-inflammatory interleukin-6. The drug produces a domestic pharmaceutical company. We have already ended with the first stage of research among children with mainly articular defeat. Olokizumab showed high efficiency and safety. And now we will begin research in children with youthful arthritis with a systemic basis – the most rare and most severe form of the disease, which is accompanied by temperature, cytokine storm and frantic inflammatory activity, life -threatening. And Interlayykin-6 is just the central cytokin, which is involved in the development of this variant of the disease, so you need to influence it. This will be a breakthrough, since now in the arsenal of rheumatologists only two drugs for the treatment of systemic youth arthritis, while for the treatment of other options – almost ten drugs.
Another new drug, which in the near future will take place of clinical trials-domestic bioanalogue of an existing foreign drug-monoclonal antibodies to the Interleukin-6 recipient. This is the first time that a clinical test of bioanalog is conducted among children. It is very important to evaluate its effectiveness and safety for children with youthful arthritis with a systemic basis. We will begin testing in March.
“Masks” arthritis
– How to identify the disease in the early stages?
– Much depends on the attentiveness of doctors. There are options for arthritis that are very difficult to recognize. Including this is a youthful arthritis with a systemic principle. Often it begins at high temperature and rash, and the child begins to be treated for a respiratory infection. A blood test also does not help – its indicators are also characteristic of an infectious disease. But there is a distinctive feature – the child begins to hurt the joints. In this case, the attentive doctor will invite a rheumatologist to conduct an examination on the protocol of the diagnosis of “Juvenile arthritis”.
Before making a diagnosis, all “masks” must be excluded, because the manifestations of arthritis can be similar to symptoms of not only infections, but also oncological diseases, injuries and so on. And this must be done before the appointment of glucocorticoid hormones that relieve temperature, rash and inflammation. Otherwise, you can skip manifestations of arthritis or oncology – a person will feel completely healthy, but as soon as the effect of drugs ends, the symptoms will return.
Often juvenile arthritis starts after an infectious disease. For example, the child was ill with a respiratory or intestinal infection, and 1-2 weeks after that he has a swollen joint. In this case, it is better to consult a rheumatologist. Sometimes the disease debuts after the injury, when the child, say, fell and hit his knee. Naturally, his parents lead him to the traumatologist. And this may not be a fracture or tearing a ligament, but a damage to the joint.
It happens that there are no problems with the joints yet, but the vascular shell of the eye is already affected. And parents pay attention to this only when the child begins to see poorly, stumble upon objects. In this case, the child can get to the rheumatologist much later than we would like.
Covid tried
-Is there any connection with the Covid-19?
-Studies have shown that after Covid, autoimmune diseases often start, because SARS-COV-2 protein molecules are similar to human protein molecules, and the immune system can “get confused” between “their own” and “foreign” proteins. Our own study showed: children whose rheumatic diseases made their debut after coronavirus transferred them harder, did not respond to standard therapy, and attacks were often accompanied by a cytokine storm. Moreover, the Covid-19 could also occur as imperative. The fact that the child was ill was found out later, when an autoimmune disease was detected.
About half of the children who have already had rheumatic diseases, including juvenile arthritis, dermatomyositis and lupus, after Covid there was an exacerbation, even if they were in deep remission. For the prevention of Covid, we began to use a special drug in them. It consists of two monoclonal antibodies to the SARS-COV-2 virus-Tiksagevimab + Tsilgavimab. In fact, this is ready immunoglobulin, which when the virus enters the body, begins to fight with it. Indeed, in children who receive immunosuppressants, antibodies to SARS-COV-2 may not be developed or there will be too few of them. We applied antibodies in 300 children and received an amazing answer: only six children fell ill with a covid, and we did not fix side effects. The effect remained for 6–9 months. Now domestic pharmaceutical companies are working on similar drugs for new coronavirus strains.
Source: aif.ru