title: British isles survey of methotrexate monitoring practice during treatment of juvenile idiopathic arthritis.
abstract: OBJECTIVE
  We surveyed current pediatric rheumatology monitoring practice in methotrexate treatment of juvenile idiopathic arthritis in the British Isles, and experiences of significant side effects during methotrexate monitoring.
  
  
  METHODS
  Single-center responses were sought from the current British Society for Pediatric and Adolescent Rheumatology membership, using a web-based survey tool.
  
  
  RESULTS
  Thirty-three centers across the British Isles responded. Twenty-eight centers reported following British Society for Pediatric and Adolescent Rheumatology or local guidelines. Thirty-one centers were willing to modify their monitoring practice to individual circumstances. All centers used a full blood count and liver enzymes as monitoring tests. There was variation in frequency at which monitoring tests were performed, both at initiation of methotrexate therapy and once methotrexate therapy was established; 27 centers were willing to change the frequency of monitoring blood tests after a period of stability. Centers reported acting on alanine aminotransferase values ranging from 50 to 500 IU/L. Particular variation existed between smaller and larger centers. Few centers reported any experience of serious side effects, and only 1 cited a case of liver cirrhosis.
  
  
  CONCLUSIONS
  Despite specific pediatric guidance for monitoring low-dose methotrexate use in juvenile idiopathic arthritis, variation in practice exists in the British Isles. It may be that blood test monitoring could safely be performed less frequently than currently recommended. To inform future changes to guidance, we suggest establishing a prospective registry for serious side effects.
authors.affiliation: Department of Paediatric Rheumatology, Nottingham Children's Hospital, University Hospital Queen's Medical Centre, Nottingham, United Kingdom. dhawley@doctors.org.uk
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Hawley
authors.forename: Nikki
authors.initials: N
authors.lastname: Camina
authors.forename: Satyapal
authors.initials: S
authors.lastname: Rangaraj
mesh_terms: D000293:Adolescent; D016907:Adverse Drug Reaction Reporting Systems; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D002648:Child; D016903:Drug Monitoring; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate