Holzinger D, Frosch M, Föll D
Institut für Immunologie, Universitätsklinikum Münster, Röntgenstr 21, 48149 Münster.
Z Rheumatol. 2010 Aug;69(6):496-504. doi: 10.1007/s00393-010-0633-1.
Treatment with low-dose methotrexate (MTX) is an important element in the therapy of juvenile idiopathic arthritis (JIA). It could be demonstrated in placebo-controlled trials that MTX is a safe and effective drug which is generally well tolerated by children and adolescents. MTX is usually used at a dose of 10-15 mg/m(2)/week, whereby oral administration is preferred for children. Side effects occur mainly in the form of gastro-intestinal discomfort such as nausea and vomiting or raised transaminases, which can be effectively treated with folic-acid supplementation.There are no general recommendations to date regarding in particular duration and discontinuation of MTX treatment or combination treatment with other disease-modifying antirheumatic drugs or biologics. These unresolved questions are the subject of current trials in which biomarkers have an increasingly important role.
低剂量甲氨蝶呤（MTX）治疗是幼年特发性关节炎（JIA）治疗的重要组成部分。在安慰剂对照试验中已证实，MTX是一种安全有效的药物，儿童和青少年通常对其耐受性良好。MTX通常以10 - 15mg/m²/周的剂量使用，儿童首选口服给药。副作用主要表现为胃肠道不适，如恶心、呕吐或转氨酶升高，补充叶酸可有效治疗这些副作用。迄今为止，关于MTX治疗的具体持续时间和停药，或与其他改善病情抗风湿药物或生物制剂联合治疗，尚无一般性建议。这些未解决的问题是当前试验的主题，在这些试验中生物标志物发挥着越来越重要的作用。
