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Efficacy and safety of methotrexate treatment of juvenile localized scleroderma

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Our goal is to study the efficacy and safety of MTX in juvenile localized scleroderma (JLS).

Retrospective study of 59 chlidren with JLS from 3 to 17 y (M = 10.3) treated with MTX was performed. Group 1 (n = 18) – received prednisone 0.5 mg\kg for 6 weeks, taped to 0.1 mg\kg for 12 months + MTX 10 mg\body sq. weekly for 13.7 mo. Group 2 (n = 41) -MTX the same doses and duration. The efficacy was measured in 6 & 12 months using skin score, activity and sclerosis indexes (IA, IS) (1 – 3 points) of skin damage, the safety by clinical & laboratory methods. Group 1 patients had spread linear skin involvement (hemitype), with skin score significantly higher (p < 0.01) than in group 2, where children had mostly local linear skin damage. Previously 9 pts from Group 1, 31 pts from Group 2 received penicillamine (PA) with no effect.

MTX therapy was effective in 73% of children unsuccessfully treated with PA & in 98% of patients received MTX as the first medication. Effect of therapy was significantly better in pts with disease duration less than 6 mo. In Group 1 significant improvement (p < 0.01) in skin score, IA, IS had been already achieved in 6 months of treatment, in Group 2 only in 12 mo. MTX was effective in children with linear skin, periarticular contractures. Nausea was the main adverse effect, in 17% of pts, with no correlation with genetic polymorfisms of methylenetetrahydrofolate reductase.

MTX is effective and safe in linear JLS.

References

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    Weibel L, Sampaio MC, Visentin MT, Howell KJ, Woo P, Harper JI: Evaluation of methotrexate and corticosteroids for the treatment of localized scleroderma (morphoea) in children. Br J Dermatol. 2006, 155 (5): 1013-1020. 10.1111/j.1365-2133.2006.07497.x.

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Correspondence to MK Osminina.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Osminina, M., Geppe, N., Tougarinova, G. et al. Efficacy and safety of methotrexate treatment of juvenile localized scleroderma. Pediatr Rheumatol 6, P230 (2008) doi:10.1186/1546-0096-6-S1-P230

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Keywords

  • Public Health
  • Adverse Effect
  • Retrospective Study
  • Methotrexate
  • Prednisone