DISCONTINUATION OF METHOTREXATE TREATMENT IN JUVENILE RHEUMATOID-ARTHRITIS

DObjective. Children with juvenile rheumatoid arthritis (TRA) treated with methotrexate (MTX) were examined for their course after the disco ntinuation of the drug to define the relapse and remission rates and t o identify predictors of relapse. Methodology. A retrospective chart r eview of all patients with JRA was conducted in two pediatric rheumato logy centers. A total of 101 patients being treated with MTX were iden tified. Dose, response to the drug, and length of time until reaching a state of complete control were noted. The outcome of patients with a complete response in whom the drug was discontinued was examined with regards to length of time to relapse or continued remission. Results. In 25 patients, MTX was discontinued after reaching complete control of the disease. There were no statistically significant predictors of response to MTX identified. Of 25 whose MTX was discontinued, relapse occurred in 13 (52%) after a mean of 11 months after discontinuation. There was no significant difference among patients who relapsed or tho se who remained in remission as to sex, subtype of JRA, number of mont hs to complete control, or number of months in complete control until discontinuing MTX. Patients younger than 4 1/2 years at diagnosis were found to be more likely to relapse than patients diagnosed at a later age. In 10 of the patients who relapsed, complete control was induced within a mean of 7 months after restarting MTX. Conclusion. The optim al time for discontinuing MTX in children with JRA who have achieved c omplete control is unknown. Relapse occurred in approximately half of the patients in whom MTX was discontinued. Because response to reinsti tution of the drug is good, it is reasonable to discontinue MTX after prolonged complete control. It remains to be seen whether the relapse rate can be improved by waiting for longer periods of time in complete control before its discontinuation.