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Methotrexate in Linear Scleroderma: Long-Term Efficacy in Fifty Children From a Single Pediatric Rheumatology Center

Gloria Fadanelli1, Anna Agazzi2, Fabio Vittadello2

  • 1Santa Chiara Hospital, Trento, Italy.

Arthritis Care & Research
|May 21, 2020
PubMed

Insights

Methotrexate (MTX) treatment leads to long-lasting remission in most children with linear scleroderma (SSc). Early diagnosis and consistent monitoring are key for managing disease flares and improving outcomes.

Area of Science:

  • Pediatric Rheumatology
  • Dermatology
  • Immunology

Background:

  • Linear scleroderma (SSc) is a chronic autoimmune condition affecting children.
  • Methotrexate (MTX) is a common immunosuppressive agent used in pediatric rheumatology.
  • Understanding the long-term outcomes of MTX treatment in pediatric linear SSc is crucial for optimizing patient care.

Purpose of the Study:

  • To evaluate the disease course and long-term outcomes of children with linear SSc treated with methotrexate (MTX).
  • To assess the efficacy of MTX in achieving remission and preventing disease progression in pediatric linear SSc.

Main Methods:

  • Retrospective, cross-sectional study including children with linear SSc treated with MTX for over one year and followed for at least two years.
  • Disease course analyzed by relapse rates and treatment changes; relapse-free survival assessed using Kaplan-Meier analysis.
  • Disease activity and damage evaluated using the Localized Scleroderma Cutaneous Assessment Tool and thermography.

Main Results:

  • Fifty patients were included, with a mean follow-up of 7.8 years and MTX treatment of 3.1 years.
  • Complete remission rates increased with follow-up duration: 18.2% (2-5 years), 80.0% (10 years), and 87.5% (>10 years).
  • Longer treatment duration correlated significantly with fewer relapses and less tissue damage.

Conclusions:

  • Methotrexate (MTX) treatment is effective in achieving complete and sustained remission in the majority of pediatric linear scleroderma cases.
  • While moderate aesthetic and functional sequelae can occur, likely due to early damage, MTX appears to stabilize existing damage.
  • Early diagnosis, prompt MTX initiation, and continuous monitoring are vital for improving long-term outcomes in children with linear SSc.
Abstract

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