Evidence-based use of methotrexate in children with rheumatic diseases: a consensus statement of the Working Groups Pediatric Rheumatology Germany (AGKJR) and Pediatric Rheumatology Austria

Niehues, Tim; Horneff, Gerd; Michels, H.; Höck, Michaela; Schuchmann, L.

doi:10.1007/s00296-004-0537-y

Cited by 35 publications

(24 citation statements)

References 58 publications

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“…The preferred dosage is 15 mg/m 2 / week [60]. Methotrexate should be administered to children according to the present recommendations [61] (IIIA).…”

Section: Treatment With Immunosuppressives and Biologicalsmentioning

confidence: 99%

Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis

et al. 2011

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Uveitis in juvenile idiopathic arthritis (JIA) is frequently associated with the development of complications and visual loss. Topical corticosteroids are the first-choice therapy, and immunosuppression is commonly used. However, treatment has not been standardized. Representatives from the German Ophthalmological Society, Society for Childhood and Adolescent Rheumatology, and the German Society for Rheumatology reached consensus on a standardized treatment strategy according to disease severity in the individual patient. The recommendations were based on a systematic literature analysis in MEDLINE and consensus expert meetings. Evidence and recommendations were graded, and an algorithm for anti-inflammatory treatment and final statements confirmed in a Delphi method. An interdisciplinary, evidence-based treatment guideline for JIA uveitis is presented.

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“…The preferred dosage is 15 mg/m 2 / week [60]. Methotrexate should be administered to children according to the present recommendations [61] (IIIA).…”

Section: Treatment With Immunosuppressives and Biologicalsmentioning

confidence: 99%

Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis

et al. 2011

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“…mit anderen Therapeutika kombiniert werden. Bereits konsensierte Empfehlungen bezüglich des Basistherapieeinsatzes von MTX oder Etanercept sollten auch für die PsA Anwendung finden [11,19]. Bei schwerem schubweisen Verlauf sowie hoher entzündlicher Aktivität ist auch an den Einsatz von systemischen Glukokortikosteroiden zu denken.…”

Section: Therapie Der Juvenilen Psoriasisarthritisunclassified

Psoriasis und Psoriasis arthritis in childhood and adolescence

et al. 2007

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There are about 1.2-1.6 million psoriasis sufferers in Germany. In about a third of these, the disease manifests before the age of 20. A classic complication of psoriasis is psoriasis arthritis (PsA), which, from the latest figures, effects about 20% of all psoriasis patients. PsA also starts in childhood and is included under the term juvenile idiopathic arthritis (JIA). The expert round table discussion which took place in 2006 in Wörlitz elaborated the recommendations for the classification, comprehensive diagnostics and therapy of effected children and adolescents. As controlled studies are lacking, the treatment of PsA has been empirically based and carried out in analogy with the treatment of other forms of JIA. The use of methotrexate (MTX) shows a good success rate. In 2004, about a third of the patients found in the core documentation, including over 80% of children and adolescents undergoing a primary therapy, were treated with MTX, a quarter in combination with other medication. A total of 7% of all and 16% of those undergoing primary therapy were treated with etanercept, most (>80%) in combination with basis medication, usually MTX. Consensus opinion indicated that an early, and intensive local skin therapy should be applied in order to reduce inflammatory activity. If PsA is present, the early use of non-steroid anti-inflammatories as well as local therapy of the joints with the intra-articular application of glucocorticosteroids is recommended. The primary medication should preferentially be MTX, if necessary combined with other therapies. In cases of a severe, episodic progression as well as high inflammatory activity, systemic glucocorticosteroids should be considered. Further studies addressing both the clinical course of jPsA compared to the adult manifestation as well as optimal therapeutic procedures should be initiated in the near future.

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“…Ähnliche Diskussionen bei der Behandlung der kindlichen Psoriasis sind weniger klar. Einerseits setzen die pädiatri-schen Rheumatologen bereits seit vielen Jahren und mit gutem Erfolg und Verträglichkeit Methotrexat in der Therapie der juvenilen idiopathischen Arthritis, also auch der juvenilen psoriatischen Arthritis ein [14,22]. Der Einsatz von Ciclosporin ist bei der Organtransplantation im Kindesalter gut bekannt und unter dieser Indikation vergleichsweise unproblematisch [25,31,36].…”

Section: Darf Eine Kindliche Psoriasis Systemisch Behandelt Werden?unclassified

Kinder und Jugendliche mit Psoriasis

Sticherling

2012

Hautarzt

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Juvenile psoriasis shows a cumulative incidence of 1.76% until the 18th year of life and thus is important for both pediatricians and dermatologists. In contrast to psoriasis in adults, the main trigger factors are infections, mechanical trauma and stress factors and to a much lesser extent medical and recreational drugs. Apart from the classical predilection sites, the diaper area, scalp and face are mainly involved. Guttate psoriasis following streptococcal infections is a specific clinical manifestation in childhood and adolescence. Psoriasis arthritis of childhood falls into the group of juvenile idiopathic arthritis and typically presents before or simultaneously with skin symptoms. All recommended childhood vaccinations should be administered, ideally when the disease is under remission. Therapy relies heavily on topical agents like dithranol, corticosteroids, and alternatively topical calcineurin inhibitors in addition to individually adapted skin moisturizing measures. In severe cases which do not adequately respond to topical therapy, systemic treatment with classical immunomodulatory agents like methotrexate, cyclosporin, retinoids and fumarates may be initiated but all usage is off-label. The only agent licensed for the treatment of psoriasis in patients above the age of 8 years is etanercept if classical treatment has failed. Rehabilitative measures in mountain and seaside areas are reasonable for maintaining improvement and helping patient learn to deal with disease.

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Evidence-based use of methotrexate in children with rheumatic diseases: a consensus statement of the Working Groups Pediatric Rheumatology Germany (AGKJR) and Pediatric Rheumatology Austria

Cited by 35 publications

References 58 publications

Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis

Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis

Psoriasis und Psoriasis arthritis in childhood and adolescence

Kinder und Jugendliche mit Psoriasis

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