title: Accelerated nodulosis during methotrexate therapy for juvenile rheumatoid arthritis.
abstract: We describe two patients with rheumatoid factor-positive, polyarticular-onset juvenile rheumatoid arthritis in whom accelerated nodulosis developed during methotrexate therapy. Although they had only a few nodules at diagnosis, the nodules increased in number and size 3 to 4 months after the start of methotrexate therapy in both patients. The nodules regressed after withdrawal of methotrexate therapy in one patient and were arrested with the addition of hydroxychloroquine in the other. Physicians treating patients with methotrexate for juvenile rheumatoid arthritis must be aware of this extraarticular side effect.
authors.affiliation: Department of Pediatrics, University of Toronto, Hospital for Sick Children, Ontario, Canada.
authors.forename: M A
authors.initials: MA
authors.lastname: Muzaffer
authors.forename: R
authors.initials: R
authors.lastname: Schneider
authors.forename: B J
authors.initials: BJ
authors.lastname: Cameron
authors.forename: E D
authors.initials: ED
authors.lastname: Silverman
authors.forename: R M
authors.initials: RM
authors.lastname: Laxer
mesh_terms: D000293:Adolescent; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D008727:Methotrexate / Q000009:adverse effects*; D012217:Rheumatoid Factor / Q000097:blood; D012218:Rheumatoid Nodule / Q000139:chemically induced* / Q000188:drug therapy
chemical_list: D006886:Hydroxychloroquine; D012217:Rheumatoid Factor; D008727:Methotrexate