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. 2001;2001(3):CD003129.
doi: 10.1002/14651858.CD003129.

Methotrexate for treating juvenile idiopathic arthritis

T Takken  1 , J Van der Net, P J Helders
Affiliations

Methotrexate for treating juvenile idiopathic arthritis

T Takken et al. Cochrane Database Syst Rev. 2001.

Update in

Abstract

Background: In both adult rheumatoid arthritis (RA) and juvenile arthritis, the focus has shifted from 'inflammation parameters' to more patient centered disability outcomes. In RA this resulted in the development of the Outcome Measures in Arthritis Clinical Trials (OMERACT), and in juvenile arthritis the Pediatric Rheumatology International Trials Organization (PRINTO) core set. This PRINTO-core set was established using a combination of statistical and consensus formation techniques. This core set contains a number of patient centered disability measures. This review systematically searched the available literature and reports the available evidence of efficacy of MTX, with special focus on patient centered disability measures in Juvenile Idiopathic Arthritis (JIA).

Objectives: To perform a systematic review on the effects of MTX on functional ability, range of motion, quality of life, overall well-being and pain for patients with JIA.

Search strategy: The Cochrane Controlled Trials Register (CCTR) and MEDLINE were searched up to March 2001, using the search strategy sensitive for randomised controlled trials, used by the Cochrane Collaboration.

Selection criteria: Randomized controlled trials and controlled clinical trials comparing MTX against placebo or standard care in patients with Juvenile Idiopathic Arthritis (JIA) were selected.

Data collection and analysis: Two reviewers (TT, JN) determined the studies to be included in this review and extracted the data of patient centered disability measures. The data were pooled using standardized mean differences (SMD) for limited joint range score, number of joints with swelling, and number of joints with pain on motion. Physicians global assessment and parents global assessment were evaluated with pooled odds ratios (OR).

Main results: Only two studies with a total 165 JIA patients under 18 years of age were included in this review. For JIA patients, MTX therapy had small to moderate effects on patients centered disability. The effect on joint range of motion, number of joints with pain and swelling and parent's assessment of disease activity showed a relative percentage improvement from 3 to 18% greater with MTX than with placebo.

Reviewer's conclusions: Current evidence suggests that MTX does not have clinically significant effects (>20%) on patient centered disability measures in JIA patients.

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Conflict of interest statement

None known

Figures

1.1
1.1. Analysis
Comparison 1 MTX vs. Placebo ‐ Efficacy, Outcome 1 Improvement in limited joint range score.
2.1
2.1. Analysis
Comparison 2 MTX vs Placebo ‐ Efficacy, Outcome 1 Improvement in Number of Joints with Swelling (synovitis).
3.1
3.1. Analysis
Comparison 3 MTX vs Placebo ‐ Efficacy, Outcome 1 Physicians' Global Assessment of Patients' Response toTherapy (Improvement).
4.1
4.1. Analysis
Comparison 4 MTX vs Placebo ‐ Efficacy, Outcome 1 Parents assessment of disease activitiy.
5.1
5.1. Analysis
Comparison 5 MTX vs Placebo ‐ Efficacy, Outcome 1 Improvement in Number of Joints with pain on motion.
6.1
6.1. Analysis
Comparison 6 MTX: safety and toxicity, Outcome 1 withdrawals.
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References

References to studies included in this review

Giannini 1992 {published data only}
    1. Giannini EH, Brewer EJ, Kuzmina N, Shaikov A, Maximov A, Vorontsov I, et al. Methotrexate in resistant juvenile rheumatoid arthritis. Results of the U.S.A.‐U.S.S.R. double‐blind, placebo‐controlled trial. The Pediatric Rheumatology Collaborative Study Group and The Cooperative Children's Study Group. N Engl J Med 1992;326(16):1043‐9. - PubMed
Woo 2000 {published data only}
    1. Woo P, Southwood TR, Prieur AM, Dore CJ, Grainger J, David J, et al. Randomized, placebo‐controlled, crossover trial of low‐dose oral methotrexate in children with extended oligoarticular or systemic arthritis. Arthritis and Rheumatism 2000;43(8):1849‐57. - PubMed

Additional references

Dickersin 1994
    1. Dickersin, K, Scherer, R, Lefebvre, C. Identifying relevant studies for systematic reviews. BMJ 1994;309:1286‐1291. - PMC - PubMed
Felson 1995
    1. Felson DT, Anderson JJ, Boers M, Bombardier C, Furst D, Goldsmith C, Katz LM, Lightfoot R Jr, Paulus H, Strand V, et al. Preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum 1995;38(6):727‐735. [MEDLINE: ] - PubMed
Giannini 1997
    1. Giannini EH, Ruperto N, Ravelli A, Lovell DJ, Felson DT, Martini A. Preliminary definition of improvement in juvenile arthritis. Arthritis Rheum 1997;40(7):1202‐9. - PubMed
Jadad 1996
    1. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Controlled Clinical Trials 1996;17(1):1‐12. - PubMed
Lovell 1989
    1. Lovell DJ, Howe S, Shear E, Hartner S, McGirr G, Schulte M, et al. Development of a disability measurement tool for juvenile rheumatoid arthritis. The Juvenile Arthritis Functional Assessment Scale. Arthritis Rheum 1989;32(11):1390‐5. - PubMed
OMERACT 1997
    1. OMERACT III. Outcome Measures in Arthritis Clinical Trials. Cairns, Australia, April 16‐19, 1996. Proceedings. Journal Of Rheumatology 1997;24(4):763‐802. - PubMed
Onel 2000
    1. Onel, KB. Advanced in the medical treatment of juvenile rheumatiod arthritis. Curr Opin Ped 2000;12(72):75. - PubMed
Petty 1998
    1. Petty RE, Southwood TR, Baum J, Bhettat E, Glass DN, Manners P, Maldonado‐Cocco J, Suarez‐Almazor M, Orozco‐Alcala J, Prieur AM. Revision of the proposed classification criteria for Juvenile Idiopathic Arthritis: Durban 1997. J Rheumatol 1998;25(10):1991‐1994. - PubMed
Pham 1999
    1. Pham B, Cranney A, Boers M, Verhoeven AC, Wells G, Tugwell P. Validity of area‐under‐the‐curve analysis to summarize effect in rheumatoid arthritis clinical trials. J. Rheumatol. 1999;26(3):712‐716. - PubMed
Suarez‐Almazor 2000
    1. Suarez‐Almazor ME, Belseck E, Shea B, Wells G, Tugwell P. Methotrexate for rheumatoid arthritis (Cochrane Review). Cochrane Database of Systematic Reviews 2000, Issue 3. - PubMed

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