Disease-modifying anti-rheumatic drugs

Disease-modifying anti-rheumatic drugs (DMARDs) do more than simply treat the symptoms of JIA. They work by addressing the underlying causes of inflammation in the body, stabilising the activity of the immune system. 

Methotrexate

Methotrexate is the most commonly used DMARD in the treatment of JIA. It has been used for over 30 Years and has been shown in studies to benefit the majority of children treated with it. For many children, it is a key element in managing their condition, and most children who move on to treatment with the newer biologic drugs are encouraged to take them in combination with methotrexate. 

It may be taken orally in tablet or liquid form or by injection, usually with a prefilled pen device.

If your child is taking methotrexate, keep in mind that:

• It works slowly: Unlike some other drugs, methotrexate does not offer immediate relief from pain and stiffness. It acts gradually and cumulatively, and it may take up to 12 weeks from the first dose before your child will experience its full effects.
• It requires careful handling: It should not be handled if pregnant. Your nurse will provide training on how to handle the pen and give the injections.
  
• It must be taken on schedule: Methotrexate should always be taken on the same day each week. If your child misses a dose, contact your rheumatology team for advice.
• It can cause side-effects: Not all children taking methotrexate experience significant side effects, but many report feeling tired the day after receiving the medication, and some complain of nausea or stomach upset. Taking folic acid the day after receiving a dose of methotrexate can help alleviate these symptoms. (Folic acid should not be taken on the same day as methotrexate.) If your child develops an unexplained rash or bruising, fever, sore throat, mouth ulcers, or chicken pox—or if you have any other concerns—you should contact your rheumatology team immediately.
• It needs close monitoring: Children taking methotrexate require regular blood tests to monitor blood cell counts as well as kidney and liver function.

Parents of older children taking methotrexate should also urge them to take special care if they drink alcohol or are sexually active.