A Cochrane review [Abstract] 1 included 2 studies with a total of 165 subjects. Methotrexate therapy had small to moderate effects on disability. The effect on joint range of motion, number of joints with pain and swelling and physician's and parent's assessment of disease activity showed a relative percentage improvement from 3 to 23% greater with methotrexate than with placebo.
Tthe Methotrexate Advice and RecommendAtions on Juvenile Idiopathic Arthritis (MARAJIA) expert meeting developed evidence-based recommendations for the use of methotrexate in the treatment of juvenile idiopathic arthritis 2. A total of 9 key clinical issues were identified, and an evidence-based, systematic, literature review was performed. During the subsequent expert meeting, the relevant evidence was assessed and graded, and 10 recommendations were made. Methotrexate was recommended as the first-line treatment in oligoarthritis that persists despite nonsteroidal anti-inflammatory drugs (NSAIDs) and intraarticular steroid therapy, and in polyarticular disease.
Comment: The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals).
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