Radiologic progression in patients with juvenile chronic arthritis treated with methotrexate,☆☆,,★★

https://doi.org/10.1016/S0022-3476(98)70231-8Get rights and content

Abstract

We investigated the rate of radiologic progression, as measured by carpal length, in 26 children with juvenile chronic arthritis who were treated with methotrexate. After 2 years of treatment, the carpal length was significantly more deteriorated in nonresponders in both the “better” wrist (P =.001) and the “worse” wrist(P = .005). These results show that methotrexate may have a “disease modifying” potential in juvenile chronic arthritis. (J Pediatr 1998;133:262-5)

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

References (13)

  • R Schneider et al.

    Prognostic indicators of joint destruction in systemic-onset juvenile rheumatoid arthritis

  • EH Giannini et al.

    Methotrexate in resistant juvenile rheumatoid arthritis. Results of the U.S.A.-U.S.S.R. double-blind, placebo-controlled trial

    N Engl J Med

    (1992)
  • JP Edmonds et al.

    Antirheumatic drugs: a proposed new classification

    J Rheumatol

    (1993)
  • AK Poznanski et al.

    Carpal length in children—a useful measurement in the diagnosis of rheumatoid arthritis and some congenital malformation syndromes

    Radiology

    (1978)
  • P Wood

    Special meeting on: nomenclature and classification of arthritis in children

  • A Ravelli et al.

    Correlation between conventional disease activity measures in juvenile chronic arthritis

    Ann Rheum Dis

    (1997)
There are more references available in the full text version of this article.

Cited by (73)

  • Rheumatologic disorders

    2019, Pediatric Hand Therapy
  • Imaging in Pediatric Rheumatic Diseases

    2015, Textbook of Pediatric Rheumatology
  • Pharmacology and Drug Therapy: Nonbiologic Therapies

    2015, Textbook of Pediatric Rheumatology
  • Methotrexate: New uses for an old drug

    2014, Journal of Pediatrics
    Citation 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 Rheumatism
    Citation 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
View all citing articles on Scopus

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.

☆☆

Supported in part by Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S Matteo, Pavia, Italy.

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.

★★

0022-3476/98/$5.00 + 0  9/22/90681

View full text