Methotrexate Intolerance in Juvenile Idiopathic Arthritis: Definition, Risks, and Management.

Paediatr Drugs

Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Institute of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.

Published: September 2024

Juvenile idiopathic arthritis is the most common rheumatic disorder in childhood and adolescence posing a significant threat of short-term and long-term disability if left untreated. Methotrexate is a folic acid analog with various immunomodulatory properties. It has demonstrated significant efficacy for the treatment of juvenile idiopathic arthritis, often considered the preferred first-line disease-modifying anti-rheumatic drug given as monotherapy or in combination with biological drugs. Despite this, there is a considerable risk for treatment disruptions owing to the high prevalence of methotrexate intolerance, with symptoms such as nausea, stomach ache, vomiting, and behavioral symptoms. Many different risk factors for the intolerance have been proposed including gender, age, disease activity, treatment duration, dosing and administration, and genetic and psychological factors. As the studies have shown contradictory results, many questions are left unanswered. Therefore, a consensus regarding outcome measures and reporting is crucial. In this review, we describe the identification and assessment of methotrexate intolerance and evaluate potential risk factors, genetic associations as well as management strategies.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11335943PMC
http://dx.doi.org/10.1007/s40272-024-00643-9DOI Listing

Publication Analysis

Top Keywords

methotrexate intolerance
12
juvenile idiopathic
12
idiopathic arthritis
12
risk factors
8
methotrexate
4
intolerance juvenile
4
arthritis definition
4
definition risks
4
risks management
4
management juvenile
4

Similar Publications

Objective: Patients with uncontrolled gout have few treatment options. Pegloticase lowers serum urate (SU) levels, but antidrug antibodies limit SU-lowering response and increase infusion reaction (IR) risk. Methotrexate (MTX) cotherapy increases pegloticase response rates and lowers IR risk in pegloticase-naïve patients.

View Article and Find Full Text PDF

Background: Case reports suggest that calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) may trigger inflammatory flares in patients with autoimmune diseases.

Case Description: A 56-year-old woman with a history of severe migraines, experienced improvement in migraine frequency and intensity after starting fremanezumab 225 mg monthly. However, three months into treatment, she developed symmetric inflammatory polyarthralgias.

View Article and Find Full Text PDF

This case report describes Zoon's vulvitis or plasma cell vulvitis (PCV) with coexisting lichen planus (LP) treated with methotrexate. PCV is a rare, chronic, benign idiopathic inflammatory condition of the vulvar mucosa, characterized by a bright-red, chronic lesion of mucosa. Typically, it presents as atrophic, shiny, red plaques that can affect any part of the vulva and can spread symmetrically and bilaterally with the propensity of chronicity and gradual coalescence.

View Article and Find Full Text PDF

Anakinra in relapsing polychondritis: a case report and review of the literature.

Immunotherapy

December 2024

Department of Clinical Immunology and Allergy, Flinders Medical Centre, Bedford Park, South Australia.

Relapsing polychondritis is rare and affects non-synovial fibrocartilage. Currently, there is a paucity of treatment algorithms, especially for those with refractory disease. A middle-aged man presented with polychondritis affecting the nose, ears, joints, and larynx.

View Article and Find Full Text PDF
Article Synopsis
  • Pegloticase effectively lowers serum urate levels in patients with uncontrolled gout, but its use is limited by the development of anti-drug antibodies.
  • Co-administration of methotrexate (MTX) was found to enhance the urate-lowering response and reduce the risk of infusion reactions, benefiting patients with limited treatment options.
  • In a study involving 100 patients, those receiving pegloticase and MTX showed greater improvements in gout response rates compared to those receiving pegloticase and a placebo after 52 weeks of treatment.
View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!