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.
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http://dx.doi.org/10.1007/s40272-024-00643-9 | DOI Listing |
ACR Open Rheumatol
January 2025
Amgen, Inc (formerly Horizon Therapeutics plc), Deerfield, Illinois.
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 PDFARP Rheumatol
January 2025
ULS Gaia e Espinho.
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.
Cureus
December 2024
Department of Dermatology, Beaumont Hospital, Dublin, IRL.
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 PDFImmunotherapy
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 PDFRheumatol Adv Pract
November 2024
Rheumatology, Western Washington Arthritis Clinic, Bothell, WA, USA.
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