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Morbidity associated with long-term methotrexate therapy in juvenile rheumatoid arthritis

L D Graham1, B L Myones, R F Rivas-Chacon

  • 1Division of Immunology/Rheumatology, Children's Memorial Hospital, Chicago, IL 60614.

The Journal of Pediatrics
|March 1, 1992
PubMed

Insights

Methotrexate (MTX) therapy is generally well-tolerated in children with juvenile rheumatoid arthritis, with few adverse effects observed during long-term treatment. Most patients tolerated MTX well, with no permanent discontinuations due to side effects.

Area of Science:

  • Pediatric Rheumatology
  • Pharmacology
  • Clinical Medicine

Background:

  • Juvenile rheumatoid arthritis (JRA) is a chronic autoimmune disease affecting children.
  • Long-term management of JRA often involves disease-modifying antirheumatic drugs (DMARDs).
  • Methotrexate (MTX) is a common DMARD used in pediatric rheumatology.

Purpose of the Study:

  • To evaluate the safety and adverse effects of long-term methotrexate (MTX) therapy.
  • To assess MTX's impact on pulmonary and liver function in pediatric patients.
  • To determine the tolerability of MTX in children with polyarticular juvenile rheumatoid arthritis.

Main Methods:

  • Retrospective review of 62 pediatric patients with polyarticular JRA.
  • Analysis of pulmonary function tests (PFTs) before and during MTX therapy.
  • Monitoring of liver function tests (LFTs) and percutaneous liver biopsies.

Main Results:

  • No pulmonary function abnormalities were detected in patients undergoing PFTs.
  • Transient liver function abnormalities occurred in 9 out of 62 patients.
  • No cases of fibrosis or cirrhosis were observed in liver biopsies; one case of macrocytic anemia resolved after drug discontinuation.

Conclusions:

  • Methotrexate (MTX) appears to be well-tolerated in children with juvenile rheumatoid arthritis.
  • Long-term MTX therapy in this pediatric population showed a favorable safety profile.
  • MTX may be better tolerated in children with JRA compared to adults with rheumatoid arthritis.

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