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Pulmonary function in children with juvenile idiopathic arthritis and effects of methotrexate therapy
H Schmeling1, V Stephan, S Burdach
1Department of Paediatrics, Martin-Luther University Halle-Wittenberg, 06120 Halle, Germany.
Insights
Low-dose methotrexate is generally safe for juvenile idiopathic arthritis patients, with rare instances of lung function impairment even after long-term use. This study found no significant adverse pulmonary effects in most children treated with methotrexate.
Area of Science:
- Pediatric Rheumatology
- Pulmonology
- Pharmacology
Background:
- Methotrexate is a common treatment for juvenile idiopathic arthritis (JIA).
- Concerns exist regarding potential lung function impairment as an adverse effect of methotrexate therapy.
- Limited data is available on methotrexate's pulmonary safety in pediatric populations.
Purpose of the Study:
- To assess lung function in children with JIA receiving methotrexate.
- To identify any adverse pulmonary effects associated with methotrexate treatment in JIA patients.
Main Methods:
- Pulmonary function tests, including diffusion capacity for carbon monoxide (DLCO-SB), were conducted on 89 children with JIA.
- Forty-five percent of participants were treated with methotrexate for a median of 24 months.
- Clinical and radiological assessments for pulmonary disease were performed, excluding cases of asthma.
Main Results:
- Two children with asthma showed moderate airway obstruction.
- No obstructive or restrictive ventilation alterations were observed in other patients.
- Two JIA patients exhibited reduced CO diffusion capacity (64% and 67%), with one on methotrexate.
Conclusions:
- Low-dose methotrexate appears safe for lung function in JIA patients, even with prolonged treatment.
- Lung function impairment is a rare adverse event in children with JIA treated with methotrexate.
- Findings contrast with studies in adult rheumatoid arthritis patients, suggesting a different risk profile in JIA.
Objective:
To evaluate impairment of lung function as an adverse effect associated with methotrexate therapy in patients with juvenile idiopathic arthritis (JIA).
Methods:
We performed pulmonary function testing including diffusion capacity for carbon monoxide as measured by the single breath method (DLCO-SB) in 89 children with juvenile idiopathic arthritis. Forty (45%) were treated with methotrexate for a median of 24 months (range 3 to 120 months). Except for the presence of asthma in two children, there was no clinical or radiological evidence of pulmonary disease.
Results:
Pulmonary function testing demonstrated moderate airway obstruction in two children with known bronchial asthma. Neither obstructive nor restrictive alteration of ventilation was found in any other patient. Two juvenile idiopathic arthritis patients showed a reduced CO diffusion capacity of 64 and 67%. One of them was treated with methotrexate.
Conclusions:
With regard to lung function impairment treatment with low dose methotrexate appears to be safe even when performed for several years reaching a total amount of up to 3.5 g. In contrast to studies performed in adult rheumatoid arthritis patients, in children with juvenile idiopathic arthritis impairment of lung function is a rare event.