Liver biopsy findings in patients with juvenile rheumatoid arthritis receiving long-term, weekly methotrexate therapy☆,☆☆,★

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Abstract

We performed percutaneous liver biopsy in nine children who had received a weekly dose of methotrexate, 10 mg/m2 per week, for at least 3 years to address the concern about subclinical liver toxicity from single, weekly, low-dose methotrexate therapy for juvenile rheumatoid arthritis. No patient had clinical or biochemical evidence of liver injury. All biopsy results were interpreted as normal. These results suggest that the recommendations of the American College of Rheumatology for adults receiving single weekly methotrexate therapy for rheumatoid arthritis can be extended to children. (J PEDIATR 1996;128:149-51)

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Subjects

The study subjects were nine girls (mean age 9.5 years, range 7 to 13 years) with JRA who have been treated with MTX continuously for 3 years or more (Table). They are followed at Rainbow Babies and Childrens Hospital, Division of Pediatric Rheumatology. The onset mode of JRA was polyarticular in seven and systemic in two; no patient has pauciarticular JRA. Rheumatoid factor was not detected in any patient. All had been treated with nonsteroidal antiinflammatory drugs to which MTX was added

DISCUSSION

The reported side effects caused by low-dose weekly (10 to 15 mg/m2) MTX therapy in patients with JRA have been mild and reversible, notably nausea, vomiting, stomatitis, and transient elevation of serum aminotransferase values.3, 4 Although MTX has a well-defined acute toxicity profile in children, there is a lack of information regarding long-term hepatotoxicity, particularly in patients treated with the dosage schedule used in JRA. In 1955 an increased prevalence of hepatic fibrosis at

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From the Divisions of Pediatric Gastroenterology and Nutrition, Pediatric Rheumatology, and Pediatric Pathology, Rainbow Babies and Childrens Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio

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Reprint requests: Subra Kugathsan, MD, Division of Pediatric Gastroenterology and Nutrition, Rainbow Babies and Childrens Hospital, 11100 Euclid Ave., Cleveland, OH 44106.

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