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 .
Methotrexate intolerance in oral and subcutaneous administration in patients with juvenile idiopathic arthritis: a cross-sectional, observational study.
OBJECTIVES Methotrexate ( MTX ) is the cornerstone disease-modifying anti-rheumatic drug ( DMARD ) in juvenile idiopathic arthritis ( JIA ) . In Dutch patients , MTX intolerance occurred frequently and was associated with subcutaneous ( SC ) administration . The aim of this study was to assess the prevalence of MTX intolerance and its association with the route of administration in a German cohort of JIA patients . METHODS A cross-sectional study of JIA patients on MTX  was performed . Primary outcome was MTX intolerance , which was determined using the vali date d  Methotrexate Intolerance Severity Score ( MISS ) question naire . The prevalence of gastrointestinal adverse effects and MTX intolerance was compared between patients on MTX  SC and MTX administered orally ( PO ) . RESULTS Of 179 JIA patients on MTX  , 73 ( 40.8 % ) were intolerant . The odds of MTX intolerance were higher in patients using MTX exclusively SC compared to exclusively PO ( adjusted odds ratio 3.37 [ 95 % confidence interval 1.19 - 10.0 ] ) . There was strong evidence that the former experienced more behavioural complaints ( 76.1 % vs. 47.4 % , p=0.001 ) and weak evidence that they experienced more abdominal pain after MTX intake ( 43.5 % vs. 27.4 % , p=0.056 ) . CONCLUSIONS The prevalence of MTX intolerance was high and exclusively SC administration of MTX was associated with MTX intolerance and behavioural adverse effects . The prevalence of gastrointestinal adverse effects was at least as high as in patients on MTX PO . The frequently held assumption that SC causes fewer side effects than PO seems unwarranted . Definite answers about the differences between SC and PO administration with respect to safety and efficacy should be obtained by r and omised trials
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 .