[Methotrexate treatment in refractory juvenile rheumatoid arthritis].
The mean time from initiation of methotrexate (MTX) treatment of juvenile rheumatoid arthritis (JRA) to partial remission of clinical symptoms and total clinical remission was assessed. 9 girls and 8 boys, from 3 to 18 years of age (mean 11.4 +/- 5.4) with active JRA by American College of Rheumatology (ACR) criteria (5 systemic, 8 polyarticular and 4 pauciarticular disease onset), who failed to respond to adequate courses of non-steroidal anti-inflammatory drugs (NSAID), steroids or disease-modifying drugs were studied. Clinic visits were scheduled at monthly intervals for physical and laboratory assessment of disease activity and drug safety. Partial response to MTX was defined a 25% reduction of the active joint count and/or articular severity score. Total clinical remission was defined as in adult rheumatoid arthritis. The duration of disease activity until enrollment ranged from 6 months to 14 years (4.5 +/- 3.7 yr); duration of therapy was 3 months to 3 years (14.6 +/- 9.3 mo) and dosage ranged from 5 to 15 mg/m2/week. Prednisone in doses below 10 mg/day and NSAID were permitted. 14 of 17 patients (82%) had a 25% reduction in joint activity after 6 weeks to 4 months (9.2 +/- 3.2 weeks); 10 (59%) went into full clinical remission after 5 to 26 months (14.3 +/- 9 months); 3 relapsed after an initial response to treatment, and 4 (23%) did not respond to MTX. The non-responders were males who required higher doses of prednisone (p < 0.0001). MTX appears to be effective therapy for children with JRA. An initial response can be expected in most patients after 9 weeks of treatment, and full clinical remission occurs after a mean of 14 months.
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Pediatrics B Dept., Rambam Medical Center, Haifa.
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D008727:Methotrexate