Frequency of relapse after discontinuation of methotrexate therapy for clinical remission in juvenile rheumatoid arthritis

Objective. To investigate the outcome of children with juvenile rheumatoid arthritis (JRA) who discontinued taking methotrexate (MTX) therapy after the achievement of clinical remission. Methods. We conducted a retrospective review of the clinical course of all consecutive patients with JRA treated with MTX at our department. Results. Seventeen of the 30 patients who responded to treatment entered clinical remission 6 to 30 mo after beginning MTX therapy. All patients were discontinued from MTX within 2 to 5 mo. Five patients relapsed within 9 mo, whereas 12 patients had sustained remission for 12 mo or longer. Four of 5 children with extended pauciarticular JRA relapsed early after MTX discontinuation. These patients were less responsive to a further cycle of MTX, and 3 showed progression of radiographic joint lesions. Conclusion. These findings suggest that MTX should be continued in patients with extended pauciarticular JRA even after the achievement of clinical remission.