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Methotrexate improves the health-related quality of life of children with juvenile idiopathic arthritis
  1. Adriana Céspedes-Cruz (ivonneadri{at}
  1. Centro Medico Nacional La Raza, Mexico
    1. Raúl Gutiérrez-Suárez (rgtzs{at}
    1. Hospital General de México, Research Division, Mexico
      1. Angela Pistorio (angelapistorio{at}
      1. Istituto G. Gaslini, Italy
        1. Angelo Ravelli (angeloravelli{at}
        1. Istituto G. Gaslini, Italy
          1. Anna Loy (annaloy{at}
          1. Istituto G. Gaslini, Italy
            1. Kevin J Murray (kevin.murray{at}
            1. Princess Margaret Hospital for Children, Australia
              1. Valeria Gerloni (gerloni{at}
              1. Gaetano Pini Institute of orthopedic, Italy
                1. Nico M Wulffraat (n.wulffraat{at}
                1. University Medical Center Utrecht, Netherlands
                  1. Sheila Oliveira (sheila_knupp{at}
                  1. Instituto de Puericultura e Pediatria Martagao Gesteira, Brazil
                    1. Jo Walsh (jo.walsh{at}
                    1. Royal Alexandra Hospital, United Kingdom
                      1. Immaculada Calvo Penades (calvo_inm{at}
                      1. Hospital Universitario La Fe, Spain
                        1. Maria Giannina Alpigiani (gianninaalpigiani{at}
                        1. Istituto G. Gaslini, Italy
                          1. Pekka Lahdenne (pekka.lahdenne{at}
                          1. University of Helsinki, Finland
                            1. Claudia Saad-Magalhães (claudi{at}
                            1. Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Brazil
                              1. Elisabetta Cortis (cortis{at}
                              1. Ospedale Pediatrico Bambin Gesù, Italy
                                1. Loredana Lepore (leporel{at}
                                1. Universita' degli Studi di Trieste, Italy
                                  1. Yukiko Kimura (ykimura{at}
                                  1. Hackensack Medical Center, United States
                                    1. Carine Wouters (carine.wouters{at}
                                    1. University Hospital Gasthuisberg, Belgium
                                      1. Alberto Martini (albertomartini{at}
                                      1. University of Genoa, Italy
                                        1. Nicolino Ruperto (nicolaruperto{at}
                                        1. IRCCS G. Gaslini, Italy


                                          Objectives: To examine the change in health-related quality of life (HRQOL) and its determinants in children with juvenile idiopathic arthritis (JIA) treated with methotrexate (MTX).

                                          Methods: Patients were extracted from the PRINTO clinical trial aimed to evaluate the efficacy and safety profile of MTX administered in standard, intermediate or higher doses (10, 15 and 30 mg/m2/week respectively). Children with polyarticular-course JIA, who were less than 18 years and had a complete HRQOL assessment were included.

                                          Results: A total of 521 children were included. At baseline, JIA patients showed poorer HRQOL (p<0.01) as compared to healthy children. In 207/412 (50%) and 63 (15%) children, HRQOL values were 2 standard deviation from the mean of healthy controls in the physical and psychosocial summary scale, respectively. After 6 months of therapy with standard-dose MTX, there was a statistical significant improvement in all HRQOL health concepts, particularly in the physical ones. Similar improvements were observed in the patients non-responders to standard dose MTX who were subsequently randomized to higher dose-MTX. The presence of marked disability at baseline was associated with a 5-fold increased risk to maintain a poor physical health after 6 months of active treatment with standard-dose MTX. Other less important determinants for maintenance of poor physical well being were the baseline level of systemic inflammation, the intensity of child’s pain and an ANA-negative status.

                                          Conclusions: We report that MTX treatment produces a significant improvement across a wide range of HRQOL components, particularly in the physical domains, in patients with JIA.

                                          • health related quality of life
                                          • juvenile idiopathic arthritis
                                          • methotrexate

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