Methotrexate-associated appearance and rapid progression of rheumatoid nodules in systemic-onset juvenile rheumatoid arthritis

Arthritis and Rheumatism
F FalciniM M Cerinic

Abstract

Rheumatoid nodules are a rare extraarticular manifestation of juvenile rheumatoid arthritis (JRA), usually detected in patients with polyarticular-onset disease and positive rheumatoid factor (RF). To date, there has not been a published report of rheumatoid nodules in systemic-onset JRA. Low-dose methotrexate (MTX) is generally considered to be the most useful second-line drug in the treatment of polyarticular JRA. In adult RA, MTX has been shown to be associated with appearance and progression of rheumatoid nodules. This report describes a 3-year-old girl with RF-negative, antinuclear antibody-negative systemic JRA who developed multiple rheumatoid nodules on the scalp and trunk during MTX therapy. The first nodule developed on the scalp 6 months after MTX treatment was initiated. Previous treatment with azathioprine was not associated with nodulosis. This represents an atypical case of MTX-associated accelerated nodulosis in systemic JRA, and raises the problem of treatment plan modification in the presence of this side effect.

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Citations

Mar 20, 1998·Arthritis and Rheumatism·C A Wallace
Feb 16, 2006·Annals of the Rheumatic Diseases·K M J DouglasG D Kitas
Sep 12, 2002·Pharmacotherapy·Edna Patatanian, Dennis F Thompson
Nov 24, 2007·BioDrugs : Clinical Immunotherapeutics, Biopharmaceuticals and Gene Therapy·A M Prieur, P Quartier
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Apr 7, 2006·Clinical Rheumatology·Jee Min ParkDo Yun Lee
Jun 5, 2007·Seminars in Cutaneous Medicine and Surgery·Vicente García-Patos
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Feb 13, 2002·Arthritis and Rheumatism·M -J KaiserJ Sany
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Aug 24, 1999·The Journal of Dermatology·K A JangJ K Koh
Jul 13, 2018·Pediatric Rheumatology Online Journal·Giovanna FerraraUNKNOWN Rheumatology Italian Study Group

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