{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T07:38:26Z","timestamp":1780472306508,"version":"3.54.1"},"reference-count":18,"publisher":"Termedia Sp. z.o.o.","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reumatologia"],"published-print":{"date-parts":[[2016,2,26]]},"abstract":"<jats:p>&lt;b&gt;Objectives&lt;\/b&gt;: Methotrexate (MTX) is one of the most frequently used, highly effective disease-modifying drugs in juvenile idiopathic arthritis (JIA) therapy. The drug can be administered orally or subcutaneously, but the efficacy and tolerance of these two routes of administration raise doubts in JIA patients. The aim of the study was to evaluate MTX efficacy and tolerability after switching from the oral to the subcutaneous route of administration in children with JIA.&lt;br \/&gt; &lt;b&gt;Material and methods&lt;\/b&gt;: A single-centre, questionnaire-based assessment of MTX efficacy and tolerance in 126 unselected JIA patients with longer than 6 months of follow-up was performed. In all patients, MTX was initially administered orally. The response to MTX treatment was analysed according to American College of Rheumatology (ACR) paediatric criteria.&lt;br \/&gt; &lt;b&gt;Results&lt;\/b&gt;: Six-month MTX therapy was effective (ACR score \u2265 30) in 83 children (65.9%). The oral route of MTX administration was changed to subcutaneous in 32 patients after a mean period of 14 months due to intolerance (n = 20) or reluctance to take the oral formulation (n = 12). This group of children was significantly younger (p = 0.02) but did not differ from the group of children that continued oral treatment in other aspects, including MTX dose.&lt;br \/&gt; Six months after switching from oral to subcutaneous MTX the ACR score remained unchanged. Three children (9.4%) still reported symptoms of drug intolerance.&lt;br \/&gt; &lt;b&gt;Conclusions&lt;\/b&gt;: The switch from oral to subcutaneous MTX may increase the response rate in JIA patients with intolerance of its oral formulation. The reluctance to take oral MTX can be anticipated in early childhood, and should be considered in the individualization of therapy, having also in mind the lower risk of severe gastrointestinal adverse drug reactions.<\/jats:p>","DOI":"10.5114\/reum.2016.58757","type":"journal-article","created":{"date-parts":[[2016,5,20]],"date-time":"2016-05-20T14:36:44Z","timestamp":1463755004000},"page":"19-23","source":"Crossref","is-referenced-by-count":13,"title":["Methotrexate efficacy and tolerability after switching from oral to subcutaneous route of administration in juvenile idiopathic arthritis"],"prefix":"10.5114","volume":"54","author":[{"given":"Zbigniew","family":"\u017buber","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorota","family":"Turowska-Heydel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ma\u0142gorzata","family":"Sobczyk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Banach-G\u00f3rnicka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarzyna","family":"Rusnak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Piszczek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"El\u017cbieta","family":"M\u0119\u017cyk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3061","published-online":{"date-parts":[[2016,3,24]]},"reference":[{"key":"ref-796325","doi-asserted-by":"crossref","unstructured":"Cassidy JT, Petty RE. Juvenile idiopathic arthritis. In: Textbook of pediatric rheumatology. Cassidy JT, Petty RE (eds.). 5th ed. Saunders, Philadelphia 2005; 291-303.","DOI":"10.1016\/B978-1-4160-0246-8.50018-8"},{"key":"ref-796326","unstructured":"Petty RE, Southwood TR, Manners P, et al. International League of Associations for Rheumatology classification of JIA: second revision, Edmonton 2001. J Rheumatol 2004; 31: 390-392."},{"key":"ref-796327","doi-asserted-by":"crossref","unstructured":"Rutkowska-Sak L. Juvenile idiopathic arthritis \u2013 not only news. Termedia, Pozna\u0144 2014.","DOI":"10.53347\/rID-27852"},{"key":"ref-796328","doi-asserted-by":"crossref","unstructured":"Rutkowska-Sak L, Majdan M, T\u0142ustochowicz M, T\u0142ustochowicz W. Diagnosis and terapeutic guidelines for chronic arthritis \u2013 the transition from paediatric rheumatologist to a rheumatologist adults. Reumatologia 2013; 51: 259-264.","DOI":"10.5114\/reum.2013.37248"},{"key":"ref-796329","unstructured":"T\u0142ustochowicz W (ed.). Methotrexate \u2013 application in rheumatology and dermatology. 2nd ed. Termedia, Pozna\u0144 2014."},{"key":"ref-796330","doi-asserted-by":"crossref","unstructured":"Kaltsonoudis E, Papagoras C, Drosos A. Current and future role of methotrexate in the Therapeutic Armamentarium for Rheumatoid Arthritis. Int J Clin Rheumatol 2012; 7: 179-189.","DOI":"10.2217\/ijr.12.10"},{"key":"ref-796331","doi-asserted-by":"crossref","unstructured":"Cutolo M, Sulli A, Pizzorni C, et al. Anti-inflammatory mechanisms of methotrexate in rheumatoid arthritis. Ann Rheum Dis 2001; 60: 729-735.","DOI":"10.1136\/ard.60.8.729"},{"key":"ref-796332","doi-asserted-by":"crossref","unstructured":"de Rotte MC, Bulatovic M, Heijstek MW, et al. ABCB1 and ABCC3 Gene polymorphisms, are associated with first-year response to methotrexate in juvenile idiopathic arthritis. J Rheumatol 2012; 39: 2032-2040.","DOI":"10.3899\/jrheum.111593"},{"key":"ref-796333","doi-asserted-by":"crossref","unstructured":"Foell D, Frosch M, Schulze zur Wiesch A, et al. Methotrexate treatment in juvenile idiopathic arthritis: when is the right time to stop? Ann Rheum Dis 2004; 63: 206-208.","DOI":"10.1136\/ard.2003.005686"},{"key":"ref-796334","doi-asserted-by":"crossref","unstructured":"Songsiridej N, Furst DE. Methotrexate \u2013 the rapidly acting drug. Baillieres Clin Rheumatol 1990; 4: 575-593.","DOI":"10.1016\/S0950-3579(05)80008-1"},{"key":"ref-796335","doi-asserted-by":"crossref","unstructured":"Bulatovi\u0107 M, Heijstek MW, Verkaaik M, et al. High prevalence of methotrexate intolerance in juvenile idiopathic arthritis: development and validation of a methotrexate intolerance severity score. Arthritis Rheum 2011; 63: 2007-2013.","DOI":"10.1002\/art.30367"},{"key":"ref-796336","doi-asserted-by":"crossref","unstructured":"Salliot C, van der Heijde D. Long term safety od methotrexate monotherapy in patients with rheumatoid arthritis: a systematic literature research. Ann Rheum Dis 2009; 68: 1100-1104.","DOI":"10.1136\/ard.2008.093690"},{"key":"ref-796337","doi-asserted-by":"crossref","unstructured":"Verstappen SM, Bakker MF, Heurkens AH, et al. Adverse events and factors associated with toxicity in patients with early rheumatoid arthritis treated with methotrexate tight control therapy: The CAMERA study. Ann Rheum Dis 2010; 69: 1044-1048.","DOI":"10.1136\/ard.2008.106617"},{"key":"ref-796338","doi-asserted-by":"crossref","unstructured":"Yazici Y, Sokka T, Kautiainen H, et al. Long term safety of methotrexate in routine clinical care: discontinuation is unusual and rarely the result of laboratory abnormalities. Ann Rheum Dis 2005; 64: 207-211.","DOI":"10.1136\/ard.2004.023408"},{"key":"ref-796339","doi-asserted-by":"crossref","unstructured":"\u017buber Z, Kania U, Kr\u00f3l-Zdechlikiewicz A, et al. Analysis of clinical symptoms and laboratory profiles in children with juvenile idiopathic arthritis in Malopolska Region (Poland) in the Years 2007-2010. Maced J Med Sci 2014; 7: 56-61.","DOI":"10.3889\/oamjms.2014.010"},{"key":"ref-796340","doi-asserted-by":"crossref","unstructured":"Klein A, Kaul I, Foeldvari I, et al. Efficacy and safety of oral and parenteral methotrexate therapy in children with juvenile idiopathic arthritis: an observational study with patients from the German Methotrexate Registry. Arthritis Care Res (Hoboken) 2012; 64: 1349-1356.","DOI":"10.1002\/acr.21697"},{"key":"ref-796341","unstructured":"Rutkowska-Sak L, Rell-Bakalarska M, Lisowska B. Oral vs. subcutaneous low-dose methotrexate treatment in reducing gastrointestinal side effects. Reumatologia 2009; 47: 207-211."},{"key":"ref-796342","unstructured":"Tukov\u00e1 J, Chl\u00e1dek J, Nemcov\u00e1 D, et al. 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