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Low dose methotrexate (MTX) is widely used in the treatment of rheumatoid arthritis (RA) and various rheumatic disorders, including juvenile idiopathic arthritis (JIA). MTX is a folate antagonist, and its main adverse effects, which include haematological and hepatic toxicities, are well known. Used in high dosages in paediatric oncology, MTX has been associated with an osteopathy which is characterised by bone pain, osteoporosis, and insufficiency fractures of the legs.1 The occurrence of MTX osteopathy in patients treated with low dose MTX has been reported but is still debated.2–4
CASE REPORT
A 36 year old woman presented with severe polyarthralgias lasting for the past two months. She had a 27 year history of polyarticular type JIA, and had received prednisone up to 10 mg/day for the past …