• Arthritis
• Methotrexate

Over the past two decades, treatment of juvenile idiopathic arthritis (JIA) has improved immensely, and much of this improvement pre-dates the use of new biologic drugs. This is largely due to greater willingness to use methotrexate, a long-established disease-modifying agent, early in the disease, and greater use of intra-articular corticosteroid injections: getting the steroid directly into the joint is effective and avoids most of the side-effects.

What hasn’t been clear is whether these two modalities should be used together early on in the majority of children who present with relatively mild, …