Razi Journal of Medical Sciences

Juvenile Chronic Arthritis (JCA) and Juvenile Rheumatoid Arthritis (JRA) are a group of heterogenous idiopathic arthritis with an unclear pathogenesis, most probably, autoimmune phenomenon.

The goals of chemotherapy in JRA are to suppress chronic synovitis, to control the systemic effects of the disease on growth and developement of the patients and, ideally, to make young patients lead a normal life. MTX. has proved to be the most effective drug in this therapeutic measures of these patients, but the side effects of the drug are potentially serious and the most important cause for concern the tratment of chi/ren and young adults.

Although the mechanism of action of MTX is not fully known, it is said to modify the cytokine synthesis, and with the low dose, increase the adenosine release.

In this article we have reviewed the effect of MTX on JCA and JRA during the past 10 years. The results show wide use of MTX. on pediatr c rheumatology patients.

For the best results the drug should be used within two years after the diagnosis. The therapy should conform to the protocol of the Pediatric Rhematology Collaborative Study Group (PRCSG). The suggested dose is 10 mg/m2/ week orally. Although the side effects are potentially serious, the use of this drug, under certain considerations is acceptable. Folic acid may decrease some of the side effects. Dehydration, for any reason, and the use of cotrimoxazole should be avoided.

When the disease comes under control, the drug can be prescribed every other week.