Radiologic progression in patients with juvenile chronic arthritis treated with methotrexate☆,☆☆,★,★★
Section snippets
Patients and Methods
We reviewed the charts and the wrist radiographs of all children consecutively treated with MTX in our department between 1986 and 1996. All fulfilled the European League Against Rheumatism criteria for the diagnosis of JCA.4 Eligibility criteria for the study were: (1) polyarthritis with bilateral wrist involvement; (2) duration of MTX therapy, given as the sole second-line drug treatment, of at least 2 years; (3) baseline and 2-year wrist radiographs available for review.
Baseline predictor
Results
Data for the 26 patients with JCA who were eligible for the study were analyzed. MTX therapy was started at a dose ranging from 7.5 to 10.8 mg/m 2 /wk (median, 9.7). At baseline, all patients had a bilateral wrist radiograph available for review. We classified the 2 wrists as “worse” and “better” according to the severity of radiologic involvement. When compared with the expected values according to the equations of Poznanski et al,3 all patients showed negative carpal length, even in the less
Discussion
Harel et al7 investigated the effects of MTX on radiologic progression in JCA. By measuring carpal length in 23 patients, they found that after a mean of 2.5 years of MTX treatment, the carpometacarpal ratio was improved significantly in 11 of the 17 responders, whereas all 6 nonresponders had loss of carpal length. Compared with our study, these investigators used different measures to assess the clinical response and did not obtain wrist radiographs at standard time points; moreover, it is
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Cited by (73)
Rheumatologic disorders
2019, Pediatric Hand TherapyImaging in Pediatric Rheumatic Diseases
2015, Textbook of Pediatric RheumatologyPharmacology and Drug Therapy: Nonbiologic Therapies
2015, Textbook of Pediatric RheumatologyMethotrexate: New uses for an old drug
2014, Journal of PediatricsCitation Excerpt :Genetic studies (expanded below) have shown that several single nucleotide polymorphisms (SNPs) in the MTX metabolism pathway may also help predict response to treatment.11 In addition to improving the signs and symptoms of JIA, MTX also results in improved health-related quality of life and growth,12,13 and may also result in radiographic improvement (evidence level 4).14 Prior to discontinuing or changing MTX, one must determine the patients' adherence to therapy.
Imaging Approaches for Evaluating Peripheral Joint Abnormalities in Juvenile Idiopathic Arthritis
2012, Seminars in Arthritis and RheumatismCitation Excerpt :Consequently, comparative radiographs side to side must be obtained. Studies have demonstrated that carpal length measurement and Poznanski score determination are effective for assessing the efficacy of second-line drug therapy in JIA (31,32). Nevertheless, these studies were not randomized and included only small numbers of patients.
Radiologic investigation of pediatric rheumatic diseases
2011, Textbook of Pediatric Rheumatology
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From the Clinica Pediatrica dell’Università di Pavia and the Sezione di Radiologia Pediatrica, Servizio di Radiodiagnostica, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S Matteo; and the Dipartimento di Genetica e Microbiologia dell’Università di Pavia, Pavia, Italy.
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Supported in part by Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S Matteo, Pavia, Italy.
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Reprint requests: Alberto Martini, MD, Clinica Pediatrica dell’Università di Pavia, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S Matteo, Ple Golgi 2, 27100 Pavia, Italy.
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