Methotrexate Monotherapy in Juvenile Idiopathic Arthritis Associated Uveitis: Myth or Reality?

Francesca Tirelli, Maria Elisabetta Zannin, Fabio Vittadello, Jacopo Agnolucci, Monica Mazzarolo, Francesco Zulian

Ocular immunology and inflammation 2022 Oct-Nov

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To evaluate the long-term efficacy of methotrexate (MTX) monotherapy in patients with juvenile idiopathic arthritis-associated uveitis (JIA-U). We analyzed a cohort of patients with JIA-U treated with MTX monotherapy, divided into two groups depending on whether MTX was started before (on-MTX group) or after uveitis diagnosis (MTX-naïve group). The primary endpoint was the time between uveitis inactivity and first relapse. 84 patients entered the study. The median duration of remission on MTX monotherapy resulted 8.2 months. The on-MTX group showed a significant longer time interval between arthritis and uveitis onset and higher need for biologic agents (bDMARD). During follow-up, 40 patients (47.6%) needed bDMARD due to poor control of uveitis. Clinical remission off medication was achieved in 11.9% of patients, all belonging to the MTX-naïve group. MTX monotherapy, although effective in early stages of JIA-U, showed poor disease control in the long term.

Citation

Francesca Tirelli, Maria Elisabetta Zannin, Fabio Vittadello, Jacopo Agnolucci, Monica Mazzarolo, Francesco Zulian. Methotrexate Monotherapy in Juvenile Idiopathic Arthritis Associated Uveitis: Myth or Reality? Ocular immunology and inflammation. 2022 Oct-Nov;30(7-8):1763-1767