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Long-term methotrexate efficacy in juvenile localized scleroderma


Recent studies reported that methotrexate (MTX), appears beneficial in juvenile localized scleroderma (JLS) but little is known about its long-term efficacy. We assessed the long-term efficacy of MTX in a cohort of patients with JLS.


We prospectively followed a cohort of patients with JLS who were enrolled in a double-blind, randomized controlled trial. Oral MTX was used at a dose of 15 mg/m2 once a week (max 20 mg) for at lest 24 months; prednisone (1 mg/Kg/day, max 50 mg), in a single morning dose for 3 months was added. A target lesion was evaluated clinically, with infrared thermography and using a computerized scoring system with skin score rate (SSR) evaluation. Response to treatment was defined as: no new lesions; SSR<1; decrease lesion temperature by at least 10% compared to baseline. Treatment failure was defined by new lesions, SSR>1, or increased lesion temperature. Partial Remission (PR) was defined when the state of responder was maintained ON treatment for at least 6 months, c omplete remission (CR) the state of responder OFF treatment for at least 6 months.


65 patients have been treated with MTX during the open-label phase of the study. Seven patients were lost to follow-up. Of the remaining 58 patients, after a mean follow-up of 43 months (median 36; range 6-72 mesi), 48 (82.8%) were responders, 10 (17.2%) relapsed by 24 months since MTX start. Among the responders, 35 (60.4%) after a MTX treatment for 27.5 months (median 24, range 18-30) maintained CR for 25 months (median 24, range 2-48). None of those in CR relapsed. 13 patients (22.4%), after a mean follow-up of 20.5 months (median 15.5, range 6-45), were in PR.


Methotrexate shows a prolonged efficacy in patients with JLS.

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Correspondence to F Zulian.

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This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Zulian, F., Vallongo, C., Vittadello, F. et al. Long-term methotrexate efficacy in juvenile localized scleroderma. Pediatr Rheumatol 9 (Suppl 1), O16 (2011).

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