EXPERIENCE OF METHOTREXATE USE IN A PATIENT WITH SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS
https://doi.org/10.15690/pf.v10i5.826
Abstract
The article presents a case of early onset of systemic juvenile arthritis with active articular syndrome, severe systemic manifestations and high level of laboratory disease activity indicators. It describes successful use of methotrexate for intramuscular administration in the dose of 25 mg/m2 of body surface per week. Systemic disease manifestations terminated in a child after 1 month of treatment, acute inflammatory articular alterations, arthralgiae and morning stiffness disappeared and laboratory disease activity indicators reduced after 6 months; range of motions completely recovered in 4 out of 6 affected joints after 12 months of treatment. Inactive disease state and remission were registered after 6 and 12 months of treatment, respectively. Remission has been present for 24 months.
About the Authors
T. V. Sleptsova
Scientific Center of Children’s Health, Moscow
First Sechenov Moscow State Medical University
Russian Federation
Russian Federation
E. I. Alexeeva
Scientific Center of Children’s Health, Moscow, Russian Federation
First Sechenov Moscow State Medical University, Russian Federation
Russian Federation
Russian Federation
PhD, Professor, head of the rheumatology department at the SCCH, dean of the pediatrics faculty at the First Sechenov MSMU
R. V. Denisova
Scientific Center of Children’s Health, Moscow, Russian Federation
Russian Federation
Russian Federation
S. I. Valieva
Scientific Center of Children’s Health, Moscow, Russian Federation
Russian Federation
Russian Federation
T. M. Bzarova
Scientific Center of Children’s Health, Moscow, Russian Federation
Russian Federation
Russian Federation
K. B. Isaeva
Scientific Center of Children’s Health, Moscow, Russian Federation
Russian Federation
Russian Federation
E. V. Mitenko
Scientific Center of Children’s Health, Moscow, Russian Federation
Russian Federation
Russian Federation
References
1. Cassidy J., Petty R. Texbook of paediatric rheumatology, 6th еd. Elsevier Saunders. 2011.
2. Alekseeva E. I., Litvitskii P. F. Revmatoidnyi artrit. Etiologiya, patogenez. Klinika. Algoritmy diagnostiki i lecheniya [Rheumatoid Arthritis. Etiology, Pathogenesis. Clinical Picture. Algorithms for Diagnosis and Treatment]. Moscow, Vedi, 2007. 359 p.
3. Kroot E.J.A., vanLeeuwen M. A., vanRijswijk M. H. et al. No increased mortality in patient with rheumatoid arthritis: up to 10 years of follow–up from disease onset. Ann. Rheum. Dis. 2000; 59: 954–958.
4. Klinicheskie rekomendatsii. Revmatologiya. Pod red. E. L. Nasonova [Clinical Guidelines. Rheumatology.Edited by E. L. Nasonov]. Moscow, GEOTAR-Media, 2005. pp. 25–71, 120–140.
5. Timothy Beukelman, Nivedita M. Patkar, Kenneth G. Saag, Sue Tolleson-Rinehart, Randy Q. Cron, Esi Morgan Dewitt, Norman T. Ilowite, Yukiko Kimura, Ronald M. Laxer, Daniel J. Lovell, Alberto Martini, C. EglaRabinovich, NicolinoRuperto. American College of Rheumatology Recommendations for the Treatment of Juvenile Idiopathic Arthritis: Initiation and Safety Monitoring of Therapeutic Agents for the Treatment of Arthritis and Systemic Features. Arthritis Care & Research. 2011; 63 (4): 465–482.
6. Fleischmann R. Safety and efficacy of disease-modifying antirheumatic agents in rheumatoid arthritis and juvenile rheumatoid arthritis. Expert Opin. Drug. Saf. 2003; 2 (4): 347–365.
7. Alekseeva E. I., Shakhbazyan I. E. Autoimmunnye bolezni = Autoimmune diseases. 2002; 5: 127.
8. Hashkes P. J., Laxer R. M. Medical treatment of juvenile idiopathic arthritis. JAMA. 2005; 294 (13): 1671–1684.
9. Nasonov E. L. Protivovospalitel'naya terapiya revmaticheskikh boleznei [Anti-inflammatory Therapy of Rheumatic Diseases]. Moscow, M–Siti, 1996. 345 p.
10. Tynjala P., Vahasalo P., Tarkiainen M., Kroger L., Aalto K., Malin M., Putto-Laurila A., Honkanen V., Lahdenne P. Aggressive combination drug therapy in very early polyarticular juvenile idiopathic arthritis (ACUTE-JIA): a multicentrerandomised open-label clinical trial. Ann. Rheum. Dis. 2011 Sep;70.
11. Sudha Visvanathan, Carrie Wagner, Joseph C. Marini, Daniel J. Lovel, Alberto Martini, Ross Petty, Ruben Cuttica, Patricia Woo, Graciela Espada, Marco Gattorno, Maria T. Apaz, Eileen Baildam, Anders Fasth, Valeria Gerlonil, PekkaLahdenne, Pierre Quartier, RotraudSaurenmann, Suzanne Travers, Alan Mendelsohn, Stephen Xu, Edward H. Giannini, NicolinoRuperto, for the Paediatric Rheumatology International Trials Organization (PRINTO)1 and the Pediatric Rheumatology Collaborative Study Group (PRCSG). The effect of infliximab plus methotrexate on the modulation of inflammatory disease markers in juvenile idiopathic arthritis: analyses from a randomized, placebo-controlled trial. Pediatric Rheumatology. 2010, 8: 24.
12. Alarcon G. S. Methotrexate: Its use for the treatment of rheumatoid arthritis and other rheumatic disorders. In Arthritis and Allied Conditions. A Text book of rheumatology, 13th Edition. Еd. W. J. Koopman. Baltimore, Philadelphia, London: Williams & Wilkins. 1997; 1: 679–98.
13. Cronstein B. N. The mechanism of action of methotrexate. Rheum. Dis. Clin. North Amer. 1997; 23: 739–755.
14. Tambic-Bukovac L., Malcic I., Prohic A. Personal experience with methotrexate in the treatment of idiopathic juvenile arthritis. Rheumatism. 2002; 49 (1): 20–24.
15. Cassidy J. T. Outcomes research in the therapeutic use of methotrexate in children with chronic peripheral arthritis. J. Pediatr. 1998; 133: 179–180.
16. Klein A., Kaul I., Foeldvari I., Ganser G., Urban A., Horneff G. Efficacy and safety of oral and parenteral methotrexate therapy in children with juvenile idiopathic arthritis: an observational study with patients from the German Methotrexate Registry. Arthritis Care Res. (Hoboken). 2012 Sep; 64 (9): 1349–56.
17. Ramanan A. V., Whitworth P., Baildam E. M. Use of methotrexate in juvenile idiopathic arthritis. Arch. Dis. Child. 2003; 88: 197–200.
18. Yokota S. Classification and treatment strategy for juvenile idiopathic arthritis. Therapy. 1999; 81: 766–772.
19. Giannini E. H., Brewer E. J., Kuzmina N. et al. Methotrexate in resistant juvenile rheumatoid arthritis. Results of the USA-USSR double-blind, placebo-controlled trial. The Pediatric Rheumatology Collaborative Study Group and The Cooperative Children’s Study Group. N. Engl. J. Med. 1992; 326: 1043–1049.
20. Woo P., Southwood T. R., Prieur A. M. et al. Randomized, placebocontrolled, crossover trial of low-dose oral methotrexate in children with extended oligoarticular or systemic arthritis. Arthr Rheum. 2000; 43 (8): 1849–1857.
21. Silverman E., Mouy R., Spiegel L. et al. Leflunomide or methotrexate for juvenile rheumatoid arthritis. N. Engl. J. Med. 2005; 352: 1655–1666.
22. Albertioni F., Flato B., Seideman P. et al. Methotrexate in juvenile rheumatoid arthritis. Evidence of age dependent pharmacokinetics. Eur. J. Clin. Pharmacol. 1995; 47 (6): 507–511.
23. Tukova J., Chladek J., Nemcova D. et al. Methotrexate bioavailability after oral and subcutaneous dministration in children with juvenile idiopathic arthritis. Clin. Exp. Rheumatol. 2009; 27 (6): 1047–1053.
24. Ruperto N., Murray K. J., Gerloni V. et al. A randomized trial of parenteral methotrexate comparing an intermediate dose with a higher dose in children with juvenile idiopathic arthritis who failed to respond to standard doses of methotrexate. Arthritis Rheum. 2004; 50: 2191–2201.
25. Alsufyani K., Ortiz-Alvarez O., Cabral D. A. et al. The role of subcutaneous administration of methotrexate in children with juvenile idiopathic arthritis who have failed oral methotrexate. J. Rheumatol. 2004; 31 (1): 179–182.
26. Kugathasan S., Newman A. J., Dahms B. B. et al. Liver biopsy findings liver in patients with juvenile rheumatoid arthritis receiving long-term, weekly methotrexate therapy. J. Pediatr. 1996; 128 (1): 149–151.
27. CronR. Q., Sherry D. D., Wallace C. A. Methotrexate-induced hypersensitivity pneumonitis in a child with juvenile rheumatoid arthritis. J. Pediatr. 1998; 132 (5): 901–902.
Review
For citations:
Sleptsova T.V., Alexeeva E.I., Denisova R.V., Valieva S.I., Bzarova T.M., Isaeva K.B., Mitenko E.V. EXPERIENCE OF METHOTREXATE USE IN A PATIENT WITH SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS. Pediatric pharmacology. 2013;10(5):67-72. https://doi.org/10.15690/pf.v10i5.826
Views:
821
Email this article 