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Methotrexate for juvenile rheumatoid arthritis

Examples

Generic Name	Brand Name
methotrexate sodium	Folex PFS, MTX, Rheumatrex

How It Works

Methotrexate reduces inflammation caused by juvenile rheumatoid arthritis (JRA).

Why It Is Used

Most experts believe the potential benefits of methotrexate in children with JRA are greater than the risks of serious side effects, and methotrexate has become the preferred second-line medicine for children with JRA. It is generally reserved for children who do not respond to nonsteroidal anti-inflammatory drugs (NSAIDs). However, some children with JRA, especially those with polyarticular JRA, gain significant benefit from early methotrexate treatment. Methotrexate decreases symptoms and may slow joint damage.¹

Methotrexate may also be used for resistant chronic inflammatory eye disease (uveitis) in children with JRA.²

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.

How Well It Works

Methotrexate appears to be effective for juvenile rheumatoid arthritis.¹ Methotrexate may improve the:

Number of joints that are pain-free with motion.
Severity of pain.
Number of joints with limited motion.
Results of the erythrocyte sedimentation rate test (ESR, or sed rate).

Side Effects

Serious but rare side effects of methotrexate include:

Reduced white blood cell, red blood cell, or platelet counts.
Inflammation of the lungs (allergic pneumonitis).
Liver inflammation (abnormal liver enzyme blood tests or 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.
Mouth sores.
Hair thinning.

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.)

What To Think About

Children who are taking methotrexate should not take other medicines without the approval of the health professional who is treating their JRA. Methotrexate interacts dangerously with certain other medicines.

Frequent blood monitoring for blood cell counts and liver function enzymes should be done during methotrexate therapy.

Methotrexate may increase the risk of developing certain infections, such as shingles and pneumonia.

Methotrexate has been shown to be safe for long-term use in most children, but it is still usually tapered off and discontinued about 1 year after remission.¹

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Citations

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.

Hollister JR (2005). Rheumatic diseases. In WW Hay Jr et al., eds., Current Pediatric Diagnosis and Treatment, 17th ed., chap. 26, pp. 846–854. New York: McGraw-Hill.

WebMD Medical Reference from Healthwise

Last Updated: June 30, 2006

This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

Take Charge of Your RA Treatment

Click to View Medication Guide

Important Safety Information you should know about HUMIRA® (adalimumab).

Serious infections have happened in patients receiving HUMIRA. These infections include TB (tuberculosis) and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Some patients have died from these infections.

Before starting HUMIRA:

Tell your doctor if you think you have an infection, are being treated for an infection, have signs of an infection (such as a fever, cough, or flu-like symptoms), have any open sores on your body, have warm, red, or painful skin, get a lot of infections or have infections that keep coming back, have or had hepatitis B infection, take the medicine Kineret (anakinra), have TB or have been in close contact with someone who has TB, have lived in an area where TB or histoplasmosis is common, or were born in, lived in or traveled where there is more risk for getting TB. Your doctor should test you for TB before starting HUMIRA. If your doctor prescribes any medicine for the treatment of TB, you should start taking it before starting HUMIRA and take the full course of TB medicine prescribed.

Tell your doctor if you have any numbness or tingling, or have a disease that affects your nervous system such as multiple sclerosis or Guillain-Barré syndrome, have heart failure or other heart conditions, are scheduled for major surgery, are pregnant, become pregnant, plan to become pregnant or are breastfeeding. Tell your doctor if you are allergic to HUMIRA or any of its ingredients or are allergic to rubber or latex. The needle cover of the prefilled syringe and the pen contain dry natural rubber.

Also, tell your doctor if you have recently received or are scheduled for any vaccines. Except for live vaccines, patients may still receive vaccines while on HUMIRA. It is recommended that children with juvenile idiopathic arthritis be brought up to date with all immunizations prior to starting HUMIRA.

After starting HUMIRA:

Call your doctor right away if you get an infection, or any sign of an infection including a fever, feeling very tired, cough, flu-like symptoms, warm, red or painful skin or if you have any open sores on your body. HUMIRA can make you more likely to get infections or make any infection that you may have worse.

Possible side effects of HUMIRA:

Serious side effects, which sometimes lead to death, have happened in patients taking HUMIRA.

- Serious infections. These infections include TB (tuberculosis) and infections caused by viruses, fungi, or bacteria. Your doctor will examine you for TB and perform a test to see if you have TB. If your doctor feels that you are at risk for TB, you may be treated with medicine for TB before you begin treatment with HUMIRA and during treatment with HUMIRA. Even if your TB test is negative your doctor should carefully monitor you for TB infections while you are taking HUMIRA. Patients who had a negative TB skin test before receiving HUMIRA have developed active TB. Tell your doctor if you have any of the following symptoms while taking or after taking HUMIRA: cough, low-grade fever, weight loss, or loss of body fat and muscle.
- Certain types of cancer. There have been cases of certain kinds of cancer in patients taking HUMIRA or other TNF blockers. Patients with RA, especially more serious RA, may have a higher chance for getting a kind of cancer called lymphoma. Some patients receiving HUMIRA have developed types of cancer called non-melanoma skin cancer (basal cell cancer and squamous cell cancer of the skin), which are generally not life threatening if treated. Tell your doctor if you have a bump or open sore that doesn't heal.
- Allergic reactions. Signs of a serious allergic reaction include skin rash, a swollen face, or trouble breathing.
- Hepatitis B virus reactivation in patients that carry the virus in their blood. Tell your doctor if you have any of the following symptoms: feel unwell, poor appetite, fatigue, fever, rash or joint pain.
- Nervous system problems. Signs and symptoms include: numbness or tingling, problems with your vision, weakness in your arms or legs, and dizziness.
- Blood problems. Symptoms include a fever that does not go away, bruising or bleeding very easily, or looking very pale.
- New heart failure or worsening heart failure you already have. Symptoms include shortness of breath or swelling of your ankles or feet, or sudden weight gain.
- Immune reactions including a lupus-like syndrome. Symptoms include chest discomfort or pain that does not go away, shortness of breath, joint pain, or rash on your cheeks or arms that gets worse in the sun.

Call your doctor or get medical care right away if you develop any of the above symptoms. Your treatment with HUMIRA may be stopped.

Common side effects of HUMIRA are: injection site reactions (redness, rash, swelling, itching or bruising), upper respiratory infections (sinus infections), headaches, rash and nausea.

These are not all the side effects with HUMIRA. Ask your doctor or pharmacist for more information.

Information You Should Know About HUMIRA® (adalimumab).

HUMIRA is used to reduce the signs and symptoms of moderate to severe rheumatoidarthritis in adults, may prevent further damage to your bones and joints, and may help your ability to perform daily activities. HUMIRA can be used alone or with methotrexate or with certain other medicines. HUMIRA is used to reduce the signs and symptoms of moderate to severe polyarticular juvenile idiopathic arthritis in children 4 years of age and older. HUMIRA can be used alone or with methotrexate or with certain other medicines. HUMIRA is used to reduce the signs and symptoms of psoriatic arthritis in adults, may prevent further damage to your bones and joints, and may help your ability to perform daily activities. HUMIRA can be used alone or with certain other medicines. HUMIRA is used to reduce the signs and symptoms of ankylosing spondylitis in adults. HUMIRA is used to reduce the signs and symptoms of moderate to severe Crohn's disease in adults who have not responded well to conventional treatments. HUMIRA is also for these adults with moderate to severe Crohn's disease who have lost response or are unable to tolerate infliximab. HUMIRA is used to treat moderate to severe chronic (lasting a long time) plaque psoriasis in adults who are under the ongoing care of a physician, have the condition in many areas of their body and who may benefit from taking injections or pills (systemic therapy) or phototherapy (treatment using ultraviolet light alone or with pills).

HUMIRA is taken by injection.

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