By David Douglas
NEW YORK (Reuters Health) May 24 - Early treatment with methotrexate may help prevent uveitis in children with juvenile idiopathic arthritis (JIA), Italian and Czech investigators say.
In a May 9 online paper in the Journal of Pediatrics, Dr. Angelo Ravelli of Istituto G. Gaslini, Genoa, and colleagues note that JIA is the most common cause of chronic anterior uveitis in childhood and uveitis is the most frequent extra-articular manifestation seen overall in such children.
Methotrexate is currently the disease-modifying antirheumatic drug of first choice in JIA, but it's not clear whether its early use prevents uveitis.
To investigate further, the researchers reviewed the charts of 254 patients, a third of whom were receiving methotrexate. All had had the disease for less than a year at the first visit and had received stable management.
At a median of one year after the first visit, 16.9% of patients had developed uveitis.
The frequency of uveitis was significantly lower in those who received methotrexate compared to those who did not (10.5% vs 20.2%). Survival analysis confirmed that patients treated with methotrexate had a lower probability of developing uveitis.
Altogether, say the investigators, the findings are in keeping with other studies that suggest that methotrexate protects against uveitis.
Commenting by email, Dr. Ivan Foeldvari of the Center for Treatment of Scleroderma and Uveitis in Childhood and Adolescence at Sch�n Klinik Hamburg Eilbek, Germany, who wasn't involved in the study, told Reuters Health, "This paper confirms the general observation that since we've applied methotrexate broadly and early in the treatment of JIA, the incidence of JIA associated uveitis (has) dropped from around 30% to around 10%."
Still, Dr. Ravelli pointed out in an email to Reuters Health, a randomized trial is needed to confirm the findings.
J Pediatr 2013.
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