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Logo of annrheumdAnnals of the Rheumatic DiseasesVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Ann Rheum Dis. 2004 February; 63(2): 206–208.
PMCID: PMC1754897

Methotrexate treatment in juvenile idiopathic arthritis: when is the right time to stop?


Methods: Twenty five patients with oligoarticular and polyarticular JIA who received MTX to induce remission were followed up. MTX treatment was stopped after a mean of 3.8 months (group 1) or 12.6 months (group 2) after remission was documented. Differences in the number of relapses between these groups were looked for. Additionally, MRP8/MRP14 were analysed by ELISA in 22 patients.

Results: No difference was found in the number of relapses between patients with prolonged or early discontinued MTX treatment. Patients who were in stable remission had significantly lower MRP levels when MTX was discontinued than patients with relapses. With a cut off point for MRP8/MRP14 at 250 ng/ml, sensitivity and specificity were 100% and 70%, respectively.

Conclusion: Longer duration of MTX treatment after induction of remission does not generally improve the status of remission in patients with JIA. Residual synovial inflammation seems to influence the rate of relapses after discontinuation of MTX treatment. MRP8/MRP14 indicate residual activity even in the absence of other laboratory or clinical signs of continuing inflammation. Normal serum concentrations of MRP8/MRP14 in clinical inactive arthritis may help to identify patients in whom MTX can be safely withdrawn after remission is achieved.

Figure 1
Duration of remission. A survival analysis showed that patients after early discontinuation of MTX (group 1) had neither earlier flare ups nor more relapses than patients with late discontinuation (group 2). Point 0 indicates the time when MTX was withdrawn. ...
Figure 2
Serum levels of MRP8/MRP14. (A) MRP8/MRP14 concentrations were analysed in 22 patients with oligoarticular and polyarticular JIA before and after the start of MTX treatment. There was a significant difference between serum concentrations in active disease ...

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