Clinical and Biological Effects of Tocilizumab and Methotrexate
Clinical and Biological Effects of Tocilizumab and Methotrexate in Juveniles with Rheumatoid Arthritis Ryan La. Barre nv 20. labarre@gmail. com June 26, 2020 Results Abstract Arthritis is often a problem seen in adults, but it also affects approximately 300, 000 children in the United States. Of those cases, only a third of them are attributed to rheumatoid arthritis, which is a type of arthritis that specifically affects the joints. In severe cases, patients can be treated with methotrexate to stop the inflammation and growth of inflamed cells, in order to prevent further damage. In cases of which this treatment doesn’t work, however, another drug called tocilizumab can be used. The two drugs have very similar ingestion methods, either subcutaneously or intravenously, which allows the blood to bypass the digestive tract. Conclusions • Trial participants had either tried MXT or started on TCZ • Age nor gender changed the study's results • Regardless of original height, patients grew at a steady pace despite TCZ treatment • In 74 of 103 patients (72%), height SDS was greater than at baseline, and mean height velocity was 6. 7 ± 2. 0 cm/year Future Directions Another study on adverse effects could be done, this time on tocilizumab. In regards of this study, finding a mentor in the rheumatology field would provide better insight on the treatment of rheumatoid arthritis. Background • Arthritis is generally an adult problem, and is hard to diagnose • There are five established blood tests, and a potential biomarker • One third of juvenile idiopathic arthritis are attributed to rheumatoid arthritis • Methotrexate (MXT) and tocilizumab (TCZ) are two commonly used drugs • Both drugs are administered either subcutaneously or intravenously • TCZ is more targeted than MXT in terms of mechanisms Baseline Years Baseline Height SDS Year 1 Height SDS Year 2 Height SDS 8 -2. 879 -3. 203 -3. 545 11 -2. 314 -2. 218 -1. 833 10 -2. 530 -2. 936 N/A 14 -3. 417 -3. 082 -2. 209 10 -2. 524 -2. 024 -1. 870 12 -3. 186 -2. 049 -1. 815 10 -2. 430 -1. 999 -1. 566 12 -2. 282 -2. 749 -2. 299 7 -2. 384 -1. 960 -1. 619 12 -2. 273 -1. 740 -1. 350 8 -3. 676 -3. 954 -3. 339 Via Bharucha, K. et al. , 2018. Methods • Research clinical, peer-reviewed studies • Pub. Med and Google Scholar keywords: • "Juvenile rheumatoid arthritis", "methotrexate", "tocilizumab", "early-onset arthritis", excluding "uveitis" • Review professional experiences in the form of webinars • Keywords used on the Quest. Diagnostics website: • "Juvenile rheumatoid arthritis", "tocilizumab", "methotrexate", excluding "COVID-19" Tocilizumab, a much newer, more targeted drug, appears to be more capable of achieving remission in patients with rheumatoid arthritis. Instead of stopping bone growth (or growth in general), it attaches to cell receptors and protects the cell from harmful IL-6 proteins. Alternatively, methotrexate shuts down cellular function, therefore making it more difficult for children to grow during such an important time. Discussion • Analyzed peer-reviewed studies of clinical trials • Google Scholar provided generalized information • Pub. Med provided more specialized information • Created graphs and tables of data points found • Analyzed professional experiences through webinars, reviewed different methods of treatment and diagnosis Acknowledgements I would like to thank my parents for keeping me motivated, as well as my classmates and teacher for pushing me to continually do my best. Bibliography 1. Middlesworth, Matt. “The Definition and Causes of Musculoskeletal Disorders. ” Ergo. Plus, 10 May 2019, ergo-plus. com/musculoskeletal-disorders-msd/. 2. Maksymowych, Walter. “ 14 -3 -3 eta (η) Protein - A New Biomarker for Rheumatoid Arthritis. ” Quest Diagnostics Education Center, Apr. 2013, education. questdiagnostics. com/insights/52. 3. Maksymowych, Walter. “New Biomarker 14 -3 -3η: Advances in Diagnosing Early Rheumatoid Arthritis and Differentiating Osteoarthritis. ” Quest Diagnostics Education Center, Oct. 2014, education. questdiagnostics. com/presentations/new-biomarker-14 -3 -3 -advances-in-diagnosing-earlyrheumatoid-arthritis-and-differentiating-osteoarthritis? presentation_id=282. 4. Bergman, Martin J. “Laboratory Testing in the Diagnosis and Management of Rheumatoid Arthritis (RA) and Psoriatic Arthritis (Ps. A). ” Quest Diagnostics Education Center, Jan. 2016, education. questdiagnostics. com/presentations/laboratory-testing-in-the-diagnosis-and-managementof-rheumatoid-arthritis-ra-and-psoriatic-arthritis-psa-? 5. Maksymowych et al. Validation of prognostic biomarkers for RA: Testing of 14 -3 -3 eta according to OMERACT soluble biomarker criteria. Arthritis Rheum. 2012. 64 Suppl 10: 2118. 6. van der Heijde D. , Landewé R, Allaart C. , Tak P P, A. Marotta, Maksymowych W. 14 -3 -3η Is An Independent Predictor Of Joint Damage That Complements Crp And Anti-Ccp.
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