Monitoring methotrexate toxicity in juvenile idiopathic arthritis.

The Journal of Rheumatology
Lakshmi KocharlaHermine I Brunner

Abstract

To determine the frequency of laboratory abnormalities with methotrexate (MTX) use in patients with juvenile idiopathic arthritis (JIA); to identify potential risk factors for MTX toxicity requiring medical interventions; and to compare the frequency of liver function abnormalities in patients treated with MTX to those not treated with MTX. Results of MTX surveillance laboratory testing (SLT) available in clinical databases were reviewed for 588 children with JIA. Information on demographics, JIA features, and factors previously associated with increased frequency of SLT abnormalities was obtained. Results of SLT performed in at least 4-month intervals were available for 138 JIA patients whose JIA was not treated with MTX, and for 198 JIA patients treated with MTX plus folic acid. On SLT of the MTX-treated patients, there were 44 of 2650 (1.7%) AST tests and 90 of 2647 (3.4%) ALT tests that exceeded 2 times the upper limit of normal (> 2 ULN) in 30 children (15%). AST or ALT tests at > 2 ULN occurred more often with systemic JIA (p = 0.04), macrophage activation syndrome, during infections, in systemic antibiotic use, and after intensifying JIA drug regimens. AST or ALT results at > 2 ULN were as frequent among MTX-treated chil...Continue Reading

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Citations

Jan 27, 2011·Zeitschrift für Rheumatologie·G Keysser
Jan 26, 2011·Nature Reviews. Rheumatology·Guruprasad P Aithal
Apr 24, 2014·Arthritis Care & Research·Kelly A Rouster-StevensUNKNOWN American College of Rheumatology Pediatric Rheumatology Core Membership Group
Jun 17, 2015·Anales de pediatría : publicación oficial de la Asociación Española de Pediatría (A.E.P.)·I CalvoG Díaz Cordovés-Rego
Nov 30, 2013·The Journal of Pediatrics·Philip J HashkesFrancesco Zulian
Jun 16, 2016·Pediatric Rheumatology Online Journal·J FráňováP Doležalová
Oct 30, 2012·Immunology and Allergy Clinics of North America·Keith C Meyer, Jennifer Bierach
Aug 17, 2021·Expert Review of Clinical Immunology·Davide SelvestrelGiuliana Decorti

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