Good disease control , with therapeutic escalation to achieve low disease activity , was recommended .
OBJECTIVE To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non-systemic polyarthritis , sacroiliitis , or enthesitis .
Leflunomide or methotrexate for juvenile rheumatoid arthritis.
BACKGROUND We compared the safety and efficacy of leflunomide with that of methotrexate in the treatment of polyarticular juvenile rheumatoid arthritis in a multinational , r and omized , controlled trial . METHODS Patients 3 to 17 years of age received leflunomide or methotrexate for 16 weeks in a double-dummy , blinded fashion , followed by a 32-week blinded extension . The rates of American College of Rheumatology Pediatric 30 percent responses ( ACR Pedi 30 ) and the Percent Improvement Index were assessed at baseline and every 4 weeks for 16 weeks and every 8 weeks during the 32-week extension study . RESULTS Of 94 patients r and omized , 86 completed 16 weeks of treatment , 70 of whom entered the extension study . At week 16 , more patients in the methotrexate group than in the leflunomide group had an ACR Pedi 30 response ( 89 percent vs. 68 percent , P=0.02 ) , whereas the values for the Percent Improvement Index did not differ significantly ( -52.87 percent vs. -44.41 percent , P=0.18 ) . In both groups , the improvements achieved at week 16 were maintained at week 48 . The most common adverse events in both groups included gastrointestinal symptoms , headache , and nasopharyngeal symptoms . Aminotransferase elevations were more frequent with methotrexate than with leflunomide during the initial study and the extension study . CONCLUSIONS In patients with polyarticular juvenile rheumatoid arthritis , methotrexate and leflunomide both result ed in high rates of clinical improvement , but the rate was slightly greater for methotrexate . At the doses used in this study , methotrexate was more effective than leflunomide
Good disease control , with therapeutic escalation to achieve low disease activity , was recommended .
OBJECTIVE To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non-systemic polyarthritis , sacroiliitis , or enthesitis .