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Methotrexate, sometimes called MTX, reduces inflammation caused by 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 with JIA, especially those with polyarticular and extended oligoarticular JIA, gain significant benefit from early methotrexate treatment. Methotrexate decreases symptoms and may slow joint damage.
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 Methotrexate may:
Serious but rare side effects of methotrexate include:
Minor side effects include:
None of these side effects are permanent. Folic acid supplements may decrease the severity of side effects.
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).
Anyone taking 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 defects.
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 with chronic liver disease. Some children with kidney disease can take methotrexate, but they require an adjusted dose and careful monitoring.
Frequent blood monitoring for blood cell counts and liver function enzymes should be done during methotrexate therapy.
- 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 Elsevier.
- 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.
Last Revised: November 9, 2010
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