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Is Methotrexate OK for My Child?

Reviewed by David Zelman, MD on November 06, 2020

Methotrexate is a medicine doctors use to treat juvenile idiopathic arthritis as well as other conditions, and other kinds of arthritis.

Doctors call it a disease-modifying anti-rheumatic drug. That means it not only helps arthritis symptoms, but it also helps prevent damage to joints.

Each child with juvenile idiopathic arthritis is different. What works well for one may not work well for another. Over time, your child’s doctor may try different medicines and combinations of medicines, including methotrexate. It may be one of the first medicines they prescribe.

Your child may be given methotrexate as a pill, a liquid, or an injection. Although it takes 6-12 weeks to get the full effect, symptoms should get better within that time.

What Does Methotrexate Do?

The goal with methotrexate is to help protect your child’s joints from further damage. It does this by blocking certain immune system chemicals, or enzymes.

The medicine doesn’t cure the disease. But it does help ease, or even stop, the symptoms.

Risks

Most will do well on methotrexate, but with any medicine, there may be risks and side effects. Some to watch out for are:

Your child will have regular blood tests to check for problems. These might include:

  • Complete blood count, or CBC. This will check the number of each type of blood cell.
  • Liver enzyme tests. This test checks for liver problems.
  • Serum creatinine. This test will check the kidneys.

Your child will get these tests before they start to take the methotrexate, then every 1 to 4 months.

Your child’s doctor may recommend they take one of the B vitamins (folic acid) while on methotrexate. Taking folic acid helps prevent some of the side effects, like nausea. It also lowers some of the risks.

Benefits

Methotrexate has lots of advantages. It’s been used and studied for a long time. The risks and side effects are well known, as well as how to prevent and treat them. And, unlike some other medicines for the condition, methotrexate is inexpensive.

Studies have shown the benefits of taking this drug. Children may show overall improvement, including less inflammation and fewer joint symptoms.

WebMD Medical Reference

Sources

SOURCES:

American College of Rheumatology: "Methotrexate (Rheumatrex, Trexall, Otrexup, Rasuvo).”

Arthritis Foundation; Kids Get Arthritis Too: “9 Things Parents Should Know About Methotrexate.”

Becker M. International Journal of Clinical Rheumatology, published online 2013.

Beukelman, T. Arthritis Care & Research, published online April 4, 2011.

Ramanan, A. Archives of Disease in Childhood, published online August 27, 2002.

Ringold, S. Arthritis and Rheumatism, published online October, 2013.

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