Elsevier

The Journal of Pediatrics

Volume 163, Issue 3, September 2013, Pages 879-884
The Journal of Pediatrics

Original Article
Methotrexate Therapy May Prevent the Onset of Uveitis in Juvenile Idiopathic Arthritis

https://doi.org/10.1016/j.jpeds.2013.03.047Get rights and content

Objective

To evaluate whether early treatment with methotrexate (MTX) prevents the onset of uveitis in children with juvenile idiopathic arthritis.

Study design

The clinical charts of all consecutive patients seen between January 2002 and February 2011 who had a disease duration <1 year at first visit and had received a stable management for at least 2 years with or without MTX were reviewed. Patients who were given systemic medications other than MTX (except nonsteroidal anti-inflammatory drugs) were excluded. Patients with systemic arthritis, rheumatoid factor-positive arthritis, or enthesitis-related arthritis were also excluded. In each patient, the 2-year follow-up period after first visit was examined to establish whether uveitis had occurred.

Results

A total of 254 patients with a median disease duration of 0.3 year were included. Eighty-six patients (33.9%) were treated with MTX, whereas 168 patients (66.1%) did not receive MTX. During the 2-year follow-up, 211 patients (83.1%) did not develop uveitis, whereas 43 patients (16.9%) had uveitis a median of 1.0 year after the first visit. The frequency of uveitis was lower in MTX-treated than in MTX-untreated patients (10.5% vs 20.2%, respectively, P = .049). Survival analysis confirmed that patients treated with MTX had a lower probability of developing uveitis.

Conclusion

Early MTX therapy may prevent the onset of uveitis in children with juvenile idiopathic arthritis. Because our study may be affected by confounding by indication, the potential of MTX to reduce the incidence of ocular disease should be investigated in a randomized controlled trial.

Section snippets

Methods

The study was conducted by review of the charts of all consecutive patients who: (1) met the International League for Associations of Rheumatology (ILAR) criteria for JIA17; (2) were first seen at the study center between January 2002 and February 2011; (3) had a disease duration of <1 year at the first observation; (4) had a minimum follow-up duration after the first visit of 2 years; and (5) had received a stable management for at least 2 years after the first visit with either MTX, with or

Results

A total of 254 patients met the inclusion criteria and were eligible for enrollment in either of the 2 groups. These patients were part of a whole series of ∼900 patients with JIA who were seen at the study center during the study period. Table I shows the main demographic, clinical, and treatment characteristics of patients at their baseline visit. Overall, the series was overly represented by girls with early disease onset and positive ANA status.19 The majority of patients had the ILAR

Discussion

We investigated whether MTX therapy reduces the incidence of uveitis in children with JIA. The study sample was overly represented by girls with early disease onset and positive ANA status, a subset of JIA patients who have a high risk for the development of uvelitis.4 The homogeneity of the patient population was strengthened by the exclusion of children with systemic or RF-positive arthritis, who rarely experience ocular involvement, and of patients with enthesitis-related arthritis, who may

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  • Cited by (0)

    M.B. received the Articulum Fellowships and was supported by the Ministry of Health of Czech Republic (RVO-VFN64165/2012) and Charles University (PRVOUK P24/LF1/3). The authors declare no conflicts of interest.

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