METHOTREXATE THERAPY IN SYSTEMIC-ONSET JUVENILE RHEUMATOID-ARTHRITIS IN SAUDI-ARABIA - A RETROSPECTIVE ANALYSIS

Eighteen patients (nine girls, nine boys) with systemic onset juvenile rheumatoid arthritis (SO-JRA) treated with methotrexate (MTX) for a m ean period of 18 months (range 6-41 months) were analysed to evaluate the safety and efficacy of MTX in this disease subtype. The MTX dose r anged from 2.5 to 15 mg/week with a mean cumulative dose of 684.9 mg/p atient at the last follow-up visit. Systemic features were severe in 1 0 patients before MTX was started. None of these patients showed syste mic features at the last follow-up visit. Sixteen patients (89%) showe d improvement in both the active joint count (from a mean of 12.0 to 1 .3 joints/patient) and function class (from a mean of 3.0 to 1.3) whil e receiving MTX. Eleven patients (61%) showed a significant decrease i n the erythrocyte sedimentation rate (>50% of the initial value), an i mprovement in anaemia (haemoglobin >2 g) and reduced thrombocytosis (p latelets 2 x 10(5)). Of the patients receiving corticosteroids, three patients (20%) were able to discontinue prednisone and the dose was re duced to less than 50% of the initial dose in seven patients (47%). At these doses of MTX! no gastrointestinal, hepatic or haematological to xicity was encountered and none of the patients withdrew because of to xicity or lack of efficacy. This report suggests that MTX is an effect ive and safe treatment in controlling systemic and articular features in this subtype of JRA.