Discontinuation of Methotrexate Treatment in Juvenile Rheumatoid Arthritis

December 18, 2006

PEDIATRICS Vol. 100 No. 6 December 1997, pp. 994-997

Received Oct 8, 1996; accepted Jun 17, 1997.

Beth S. Gottlieb*, F. Keenan, Theresa Lu, and Norman T. Ilowite*

From the * Division of Pediatric Rheumatology, Department of Pediatrics,

Schneider Children's Hospital, Long Island Jewish Medical Center, Long

Island Campus for the Albert Einstein College of Medicine, New Hyde Park,

New York; and Division of Pediatric Rheumatology, Department of Pediatrics,

Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Objective. Children with juvenile rheumatoid arthritis (JRA) treated with

methotrexate (MTX) were examined for their course after the discontinuation

of the drug to define the relapse and remission rates and to identify

predictors of relapse.

Methodology. A retrospective chart review of all patients with JRA was

conducted in two pediatric rheumatology centers. A total of 101 patients

being treated with MTX were identified. Dose, response to the drug, and

length of time until reaching a state of complete control were noted. The

outcome of patients with a complete response in whom the drug was

discontinued was examined with regards to length of time to relapse or

continued remission.

Results. In 25 patients, MTX was discontinued after reaching complete

control of the disease. There were no statistically significant predictors

of response to MTX identified. Of 25 whose MTX was discontinued, relapse

occurred in 13 (52%) after a mean of 11 months after discontinuation. There

was no significant difference among patients who relapsed or those who

remained in remission as to sex, subtype of JRA, number of months to

complete control, or number of months in complete control until

discontinuing MTX. Patients younger than 41/2 years at diagnosis were found

to be more likely to relapse than patients diagnosed at a later age. In 10

of the patients who relapsed, complete control was induced within a mean of

7 months after restarting MTX.

Conclusion. The optimal time for discontinuing MTX in children with JRA who

have achieved complete control is unknown. Relapse occurred in approximately

half of the patients in whom MTX was discontinued. Because response to

reinstitution of the drug is good, it is reasonable to discontinue MTX after

prolonged complete control. It remains to be seen whether the relapse rate

can be improved by waiting for longer periods of time in complete control

before its discontinuation.

Key words: juvenile rheumatoid arthritis, methotrexate, remission relapse.

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