Effects of methotrexate combined with tocilizumab on growth and bone metabolism in children with juvenile idiopathic arthritis

Objective: This study was designed to determine the effects of methotrexate combined with tocilizumab on growth and bone metabolism in children with juvenile idiopathic arthritis (JIA). Methods: The medical records of 112 children with JIA treated in the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from March 2019 to June 2021 were collected and analyzed retrospectively. There were 51 patients treated with methotrexate alone who were assigned to the control group. The remaining 61 patients treated with methotrexate combined with tocilizumab were assigned to the observation group. The efficacy, adverse reactions, and growth after the treatment were compared between the two groups. A multiple variable logistic regression analysis was performed to analyze the independent risk factors affecting the efficacy on children. Results: The observation group had significantly better improvement rates of Pediatric American College of Rheumatology Criteria (ACR) Ped 50 and ACR Ped 70 than the control group (P<0.05). The incidence of adverse reactions in the two groups was not significantly different (P>0.05). After therapy, the observation group showed significantly lower C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels than the control group (P<0.001). Significantly higher Z values of the height and weight was shown in the observation group compared to the control group (P<0.01). The observation group showed significantly lower levels of receptor activator of nuclear factor kappa B ligand (RANKL) and beta-collagen degradation products (beta-CTX) than the control group. A significantly lower osteoprotegerin (OPG) level was seen in the observation group when compared to the control group (P<0.001). A multivariate logistic regression analysis showed that a longer course of disease, disease type, and treatment with methotrexate alone were the independent risk factors for the failure to improve the efficacy on patients (P<0.05). Conclusion: Methotrexate combined with tocilizumab can deliver good efficacy on children with JIA, quickly alleviate their clinical symptoms and laboratory indicators, and control the disease progress. It is safe because it will not increase the incidence of adverse reactions.