A 6-year-old female asked:
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6y/o on 22.5 methotrexate injrctions for 3mths for jra has occasional swelling but has stiffness &pain almost daily what should be next step? new meds

2 doctor answers
Dr. Tracy Lovell
20 years experience Rheumatology
See below: Your doctor could try increasing the Methotrexate to 25, but they may considering adding a biologic such as Enbrel or Orencia (abatacept) next.
Answered on Oct 24, 2017
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Dr. Robert Lowe
16 years experience Pediatric Rheumatology
Add a TNF-inhibitor: A dose of 22.5mg of weekly Methotrexate is a large dose for a 6yo (i rarely go above 15mg weekly for small children).The side effects and toxicity increase with marginal if any benefit. Enbrel, humira, or Remicade (infliximab) should be added immediately. There's absolutely no reason not to add one of these.They have fewer side effects and work better.Also lower Methotrexate dose to 15mg but use both.
Answered on Jun 30, 2014

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