1. Methotrexate treatment may prevent uveitis onset in patients with juvenile idiopathic arthritis: experiences and subgroup analysis in a cohort with frequent methotrexate use.
- Author
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Kostik MM, Gaidar EV, Hynnes AY, Dubko MF, Masalova VV, Snegireva LS, Chikova IA, Isupova EA, Nikitina TN, Serogodskaya ED, Kalashnikova OV, Ravelli A, and Chasnyk VG
- Subjects
- Age Factors, Arthritis, Juvenile diagnosis, Arthritis, Juvenile immunology, Child, Child, Preschool, Disease-Free Survival, Female, Humans, Kaplan-Meier Estimate, Male, Proportional Hazards Models, Risk Factors, Russia, Time Factors, Treatment Outcome, Uveitis diagnosis, Uveitis immunology, Antirheumatic Agents therapeutic use, Arthritis, Juvenile drug therapy, Methotrexate therapeutic use, Uveitis prevention & control
- Abstract
Objectives: To re-evaluate the ability of methotrexate (MTX) to prevent the onset of uveitis in Russian children with juvenile idiopathic arthritis (JIA)., Methods: The clinical charts for all consecutive patients who received a stable management for at least 2 years with or without MTX were reviewed. Patients who were given systemic medications other than MTX (except NSAID) and patients with systemic arthritis, rheumatoid factor-positive arthritis, or enthesitis-related arthritis were excluded. Each patient was examined after at least a 2-year follow-up period after the first visit to establish whether uveitis had occurred., Results: A total of 281 patients with a median disease duration of 3.8 years were included. 191 patients (68%) were treated with MTX. During the observation period, 64 patients (22.8%) developed uveitis, a median of 1.6 year after disease onset. The frequency of uveitis was lower in MTX-treated than in MTX-untreated patients (11.5% vs. 46.7%, respectively, OR=6.7 (95%CI:3.7-12.3), p=0.0000001). Survival analysis confirmed that patients treated with MTX had a lower probability of developing uveitis (HR=4.35, p=0.000001). In subgroup analysis it was shown that MTX was more preventive in boys than in girls, and in patients with JIA onset age of over 5 years compared to those with disease onset less than 5 years. The data of survival analysis of MTX prevention has shown that benefits do not depend on the number of active joints and ANA status., Conclusions: MTX therapy may prevent the onset of uveitis in children with JIA. Further randomised controlled trials are required to confirm our results.
- Published
- 2016