Efficacy and safety of methotrexate therapy for juvenile rheumatoid arthritis

Background and Purpsose: Juvenile rheumatoid arthritis (JRA) can result in disability, growth disturbance, and systemic complications. This study inve stigated the efficacy and adverse effects of oral methotrexate (MTX) therap y in Taiwanese children with JRA. Methods: The medical records of 52 Taiwanese children with JRA treated with oral MTX were retrospectively analyzed. The disease onset was polyarticula r in 22 children, oligoarticular in 13, and systemic in 17. The indication for MTX therapy was lack of efficacy of previous drugs, including two or mo re nonsteroidal anti-inflammatory drugs, in all patients. In addition, thre e patients had received hyroxychloroquine and one had received sulfasalazin c, without improvement. Corticosteroid dependency had developed in 27 patie nts prior to MTX therapy. The mean initial dose of MTX was 9.1 mg(.)m(-2)wk (-1) (range, 5-20 mg(.)m(-2)wk(-1)), and the mean maxim;ll dose was 10.2 mg (.)m(-2)wk(-1) (range, 5-20 mg(.)m(-2)wk(-1)). The mean duration of treatme nt was 23 months (range, 6-96 mo), and the mean duration of follow-up was 5 2 months (range, 10-123 mo) from the start of MTX therapy. Results: Thirty-six children (69%) showed clinical improvement and 25 child ren (48%) achieved clinical remission. The administration of MTX resulted i n mol-e than a 50% reduction in required corticosteroid dosage in six child ren, and complete discontinuation of corticosteroid in 10 children. MTX was discontinued in 18 patients following a mean of 8 months (range, 2-34 mo) of clinical remission. Relapse occurred in nine (50%) of these patients. Th irteen patients (25%) suffered from adverse effects associated with MTX tre atment. All of these adverse effects resolved spontaneously, or subsided wi thin 4 weeks following dosage reduction or discontinuation of MTX. Conclusions: Oral MTX therapy is effective and well-tolerated in Taiwanese children with JRA. It can serve as the first choice of second-line therapy in JRA.