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Methotrexate (MTX) is the cornerstone disease-modifying anti-rheumatic drug in juvenile idiopathic arthritis (JIA), because of its efficacy. Moreover, serious adverse events are rare. However, in Dutch patients, MTX intolerance, defined as gastro-intestinal side effects occurring not only after, but also before administration of MTX and when thinking of the drug, occurred frequently. MTX intolerance could lead to non-compliance and hence to decreased efficacy, eventually resulting in the necessity to replace it by more costly biologicals. Furthermore, it was observed significantly more often with subcutaneous (SC) than oral (PO) administration, contrary to widely held views. This finding was unexpected and the question about the choice of route of administration when starting MTX in daily clinical practice is still unsolved.

pediatric rheumatology online journal

Intolerance in oral versus subcutaneous administration of methotrexate in patients with juvenile idiopathic arthritis: a cross-sectional, observational study