title: Methotrexate treatment may prevent uveitis onset in patients with juvenile idiopathic arthritis: experiences and subgroup analysis in a cohort with frequent methotrexate use.
abstract: OBJECTIVE
  To re-evaluate the ability of methotrexate (MTX) to prevent the onset of uveitis in Russian children with juvenile idiopathic arthritis (JIA).
  
  
  METHODS
  The clinical charts for all consecutive patients who received a stable management for at least 2 years with or without MTX were reviewed. Patients who were given systemic medications other than MTX (except NSAID) and patients with systemic arthritis, rheumatoid factor-positive arthritis, or enthesitis-related arthritis were excluded. Each patient was examined after at least a 2-year follow-up period after the first visit to establish whether uveitis had occurred.
  
  
  RESULTS
  A total of 281 patients with a median disease duration of 3.8 years were included. 191 patients (68%) were treated with MTX. During the observation period, 64 patients (22.8%) developed uveitis, a median of 1.6 year after disease onset. The frequency of uveitis was lower in MTX-treated than in MTX-untreated patients (11.5% vs. 46.7%, respectively, OR=6.7 (95%CI:3.7-12.3), p=0.0000001). Survival analysis confirmed that patients treated with MTX had a lower probability of developing uveitis (HR=4.35, p=0.000001). In subgroup analysis it was shown that MTX was more preventive in boys than in girls, and in patients with JIA onset age of over 5 years compared to those with disease onset less than 5 years. The data of survival analysis of MTX prevention has shown that benefits do not depend on the number of active joints and ANA status.
  
  
  CONCLUSIONS
  MTX therapy may prevent the onset of uveitis in children with JIA. Further randomised controlled trials are required to confirm our results.
authors.affiliation: Saint Petersburg State Paediatric Medical University, Saint-Petersburg, Russia. mikhail.kostik@gmail.com.
authors.forename: Mikhail M
authors.initials: MM
authors.lastname: Kostik
authors.affiliation: Saint Petersburg State Paediatric Medical University, Saint-Petersburg, Russia.
authors.forename: Ekaterina V
authors.initials: EV
authors.lastname: Gaidar
authors.affiliation: Eye Care Physicians and Surgeons, Winchester, VA, USA.
authors.forename: Alla Y
authors.initials: AY
authors.lastname: Hynnes
authors.affiliation: Saint Petersburg State Paediatric Medical University, Saint-Petersburg, Russia.
authors.forename: Margarita F
authors.initials: MF
authors.lastname: Dubko
authors.affiliation: Saint Petersburg State Paediatric Medical University, Saint-Petersburg, Russia.
authors.forename: Vera V
authors.initials: VV
authors.lastname: Masalova
authors.affiliation: Saint Petersburg State Paediatric Medical University, Saint-Petersburg, Russia.
authors.forename: Ludmil S
authors.initials: LS
authors.lastname: Snegireva
authors.affiliation: Saint Petersburg State Paediatric Medical University, Saint-Petersburg, Russia.
authors.forename: Irina A
authors.initials: IA
authors.lastname: Chikova
authors.affiliation: Saint Petersburg State Paediatric Medical University, Saint-Petersburg, Russia.
authors.forename: Eugenia A
authors.initials: EA
authors.lastname: Isupova
authors.affiliation: Saint Petersburg State Paediatric Medical University, Saint-Petersburg, Russia.
authors.forename: Tatiana N
authors.initials: TN
authors.lastname: Nikitina
authors.affiliation: Saint Petersburg State Paediatric Medical University, Saint-Petersburg, Russia.
authors.forename: Elena D
authors.initials: ED
authors.lastname: Serogodskaya
authors.affiliation: Saint Petersburg State Paediatric Medical University, Saint-Petersburg, Russia.
authors.forename: Olga V
authors.initials: OV
authors.lastname: Kalashnikova
authors.affiliation: Università degli Studi di Genova; and Istituto Giannina Gaslini, Genova, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Ravelli
authors.affiliation: Saint Petersburg State Paediatric Medical University, Saint-Petersburg, Russia.
authors.forename: Vyacheslav G
authors.initials: VG
authors.lastname: Chasnyk
mesh_terms: D000367:Age Factors; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012426:Russia; D013997:Time Factors; D016896:Treatment Outcome; D014605:Uveitis / Q000175:diagnosis / Q000276:immunology / Q000517:prevention & control*
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate