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Methotrexate, sometimes called MTX, reduces inflammation caused
juvenile idiopathic arthritis (JIA).
Most experts believe the potential
benefits of methotrexate in children with JIA are greater than the risks of
serious side effects, and methotrexate has become the preferred second-line
medicine for children with JIA. It is generally reserved for children who do
not respond to nonsteroidal anti-inflammatory drugs (NSAIDs).
But some children who have JIA, especially those with
polyarticular and extended oligoarticular JIA, gain significant benefit from early
methotrexate treatment. Methotrexate reduces symptoms and may slow joint
Methotrexate may also be used
for resistant chronic inflammatory eye disease (uveitis) in
children with JIA.
Methotrexate appears to be
effective for juvenile idiopathic arthritis.1
Serious but rare side effects of
Minor side effects include:
None of these side effects are permanent.
Folic acid supplements may decrease the severity of
Effects on blood cells and liver inflammation can be
detected early by regular blood tests (every 1 to 2 months) and almost always
return to normal when methotrexate is discontinued. Regular blood tests may
help detect liver inflammation. In very rare cases, inflammation can lead to
more serious liver scarring (fibrosis or cirrhosis).
methotrexate must avoid alcohol use to prevent
significant drug interactions.
Women taking methotrexate should
avoid becoming pregnant, as the drug causes miscarriage and possibly birth
See Drug Reference for a full list of side effects. (Drug
Reference is not available in all systems.)
Children who are taking
methotrexate should not take other medicines without the approval of the doctor who is treating their JIA. Methotrexate interacts dangerously with
certain other medicines. Methotrexate should
not be used in children who have chronic liver disease. Some children with kidney
disease can take methotrexate, but they require an adjusted dose and careful
Frequent blood monitoring for blood cell
counts and liver function enzymes should be done during methotrexate
Methotrexate may increase the risk for certain
infections, such as
Methotrexate has been shown to
be safe for long-term use in most children, but it is still usually tapered off
and stopped about 1 year after
Complete the new medication information form (PDF)new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Nistala K, et al. (2009). Juvenile idiopathic arthritis. In
GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 8th ed., vol. 2, pp. 1657–1675. Philadelphia: Saunders
Giannini EH, Brunner HI (2005). Treatment of juvenile
rheumatoid arthritis. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions, 15th ed., vol. 1, pp.
1301–1318. Philadelphia: Lippincott Williams and Wilkins.
June 5, 2012
Susan C. Kim, MD - Pediatrics & John Pope, MD - Pediatrics
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