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How It Works
Methotrexate, sometimes called MTX, reduces inflammation caused
juvenile idiopathic arthritis (JIA).
Why It Is Used
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
Methotrexate may also be used
for resistant chronic inflammatory eye disease (uveitis) in
children with JIA.
How Well It Works
Methotrexate appears to be
effective for juvenile idiopathic arthritis.1
- Decrease pain and allow more movement.
- Help control rash.
- Help with eye inflammation.
Serious but rare side effects of
- Low blood counts.
- Inflammation of the lungs (allergic
- Liver inflammation (abnormal liver enzyme blood tests
hepatitis) or mild to moderate scarring (fibrosis).
Liver inflammation or fibrosis seems to be less common and less severe in
children than in adults.
- Severe liver damage (severe scarring or
cirrhosis). Cirrhosis is not reversible, but it is
rare and is most often seen in patients with underlying liver disease,
diabetes, or alcohol abuse.
Minor side effects include:
- Stomach and intestinal symptoms (nausea,
vomiting, diarrhea, or stomach upset). If your child becomes severely
dehydrated from vomiting or diarrhea, methotrexate
should be stopped until the symptoms resolve.
- Hair thinning.
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.)
What To Think About
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
Frequent blood monitoring for blood cell
counts and liver function enzymes should be done during methotrexate
Methotrexate may increase the risk of developing 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
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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.