Related Experiment Videos

Low-dose methotrexate therapy for intravenous immunoglobulin-resistant Kawasaki disease

Taek Jin Lee1, Ki Hwan Kim, Jin-Kyong Chun

  • 1Department of Pediatrics, College of Medicine, Pochon CHA University, Seongnam, Korea.

Yonsei Medical Journal
|October 31, 2008
PubMed
Abstract

Insights

Low-dose oral methotrexate (MTX) effectively treated Kawasaki disease (KD) resistant to intravenous immunoglobulin (IVIG), rapidly reducing fever and inflammation markers without adverse effects.

Area of Science:

  • Pediatric Rheumatology
  • Immunology
  • Pharmacology

Background:

  • Kawasaki disease (KD) is a critical pediatric vasculitis.
  • Intravenous immunoglobulin (IVIG) is the standard treatment, but some patients exhibit resistance.
  • Persistent fever and inflammation indicate treatment failure and risk of coronary artery lesions (CALs).

Purpose of the Study:

  • To evaluate the efficacy of low-dose oral methotrexate (MTX) in patients with IVIG-resistant Kawasaki disease (KD).

Main Methods:

  • Patients with persistent or recurrent fever post-IVIG received low-dose oral MTX (10mg/BSA) weekly.
  • Clinical and laboratory parameters, including fever duration, body temperature, and C-reactive protein (CRP) levels, were monitored.
  • The incidence of coronary artery lesions (CALs) was assessed.

Main Results:

  • Seventeen patients with IVIG-resistant KD were treated with MTX.
  • MTX therapy led to a significant decrease in median body temperature within 24 hours (38.6°C vs. 37.0°C).
  • Median CRP levels significantly reduced one week after MTX initiation (8.9mg/dL vs. 1.2mg/dL), with no observed adverse effects.

Conclusions:

  • Low-dose oral MTX is effective in rapidly resolving fever and improving inflammatory markers in IVIG-resistant KD.
  • MTX demonstrates a favorable safety profile in this patient cohort.
  • Further multicenter, placebo-blinded trials are warranted to confirm MTX's impact on coronary artery outcomes.

Related Concept Videos

Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents01:29

Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents

Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel Disease...
Rheumatic Heart Disease III: Medical Management01:21

Rheumatic Heart Disease III: Medical Management

Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
Myocarditis III: Medical Management01:14

Myocarditis III: Medical Management

Myocarditis: Comprehensive Medical ManagementMyocarditis, the heart muscle inflammation, requires a comprehensive medical management strategy that addresses the underlying cause, provides supportive care, manages symptoms, and reduces cardiac workload.Infections and Autoimmune CausesAdminister appropriate antimicrobial therapy when an infectious agent causes myocarditis. For instance, penicillin treats infections caused by Group A Streptococcus. In cases where autoimmune processes are...
Endocarditis III: Medical Management01:18

Endocarditis III: Medical Management

Infective endocarditis management involves a multifaceted approach encompassing infection prevention, lifestyle modifications, pharmacological therapy, and surgical management.Infection Prevention:Hand Hygiene: Thorough handwashing is crucial to prevent the spread of infection. Hand hygiene should be performed regularly, especially before and after using the restroom.Oral Hygiene: Good oral hygiene is essential. It includes brushing teeth immediately after waking up and before bed, flossing...
Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
Inflammatory Bowel Disease IV: Pharmacological Management01:29

Inflammatory Bowel Disease IV: Pharmacological Management

Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
Pharmacologic...