F. Bruder Stapleton, MD reviewing Ravelli A et al. Lancet 2017 Feb 2. Wulffraat N. Lancet 2017 Feb 2.

After 12 months of therapy, remission in injected joints was similar with or without methotrexate.

Oligoarticular (affecting ≤4 joints) juvenile inflammatory arthritis (JIA) is a common type of pediatric chronic arthritis in white children. It leads to progressive joint involvement in 25% to 50% of patients. Intraarticular corticosteroids are typically used to treat this condition, though evidence-based therapeutic guidance is scant.

In the current prospective, open-label trial, investigators in Italy evaluated whether adding methotrexate to intraarticular corticosteroid therapy increased efficacy in achieving clinical arthritis remission. They randomized 207 children with oligoarticular JIA to receive intraarticular corticosteroids alone or in combination with oral methotrexate (15 mg/m2; maximum dose, 20 mg) plus folinic acid weekly for 12 months.

Seventy-seven percent of children were injected in multiple joints. Rates of complete remission in injected joints at 12 months (primary outcome) were similar between groups (34% with injected corticosteroids alone and 39% with added methotrexate). Inactive disease at 12 months was also similar — 27% in the corticosteroids alone group and 36% in the added methotrexate group. The probability of remission in all injected joints was higher in the methotrexate group at 6 and 12 months. New-onset uveitis was similar in the two groups. Methotrexate produced systemic adverse events in 17% of recipients.

CITATION(S):

Ravelli A et al. Intra-articular corticosteroids versus intra-articular corticosteroids plus methotrexate in oligoarticular juvenile idiopathic arthritis: A multicentre, prospective, randomised, open-label trial. Lancet 2017 Feb 2; [e-pub]. 

Wulffraat N.The value of old drugs for juvenile idiopathic arthritis. Lancet 2017 Feb 2;; [e-pub]. 

JWatch