BARBARA ANSELL SERIES

Use of methotrexate in juvenile idiopathic arthritis

A V Ramanan¹, P Whitworth², E M Baildam¹

¹ Department of Paediatric Rheumatology, Royal Manchester Children’s Hospitals, Charlestown Road, Manchester, UK
² Department of Paediatric Rheumatology, Birmingham Children’s Hospital, Birmingham, UK

Correspondence to:
Correspondence to:
Dr A V Ramanan, 508, 77 Elm Street, Toronto, Canada M5G 1H4;
avramanan{at}hotmail.com

Methotrexate (MTX) has transformed the outlook for children with juvenile idiopathic arthritis (JIA). Most of the evidence from uncontrolled clinical trials suggests that MTX is an effective agent for treating active JIA. Data from controlled clinical trials suggests that MTX has statistically significant effects on patient centred disability measures in JIA patients with active arthritis. Although we would like a much larger study directed evidence base for our use of the drug, the studies that have been done are sound and have been followed by a change in clinical expectations and advice that speak of qualitative evidence from clinical practice, confirming the scientifically acquired data. Randomised controlled multicentre trials using sufficient numbers of patients, including functional assessment and quality of life measures, are needed to confirm the long term efficacy and safety of MTX in JIA.

Keywords: juvenile idiopathic arthritis; methotrexate

Abbreviations: DHFR, dihydrofolate reductase; JIA, juvenile idiopathic arthritis; NSAID, non-steroidal anti-inflammatory drug; JRA, juvenile rheumatoid arthritis; MTX, methotrexate; RA, rheumatoid arthritis

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