Conventional synthetic disease-modifying antirheumatic drugs for enthesitis-related arthritis
The approach to managing enthesitis-related arthritis, and the role of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) in disease management, is described in Management for enthesitis-related arthritis.
A csDMARD (methotrexate or sulfasalazine) is used by specialists to induce and maintain clinical remission of arthritis.
Methotrexate is used for peripheral arthritic disease and may also be useful for chronic uveitis. Oral bioavailability of methotrexate plateaus above 15 mg; subcutaneous administration may be considered if doses higher than 15 mg are ineffective and may also have the benefit of reducing methotrexate-induced nausea. The usual paediatric dosage of methotrexate is:
1methotrexate 10 to 20 mg/m2 up to 25 mg orally, on one specified day once weekly1 methotrexate methotrexate methotrexate
OR
1methotrexate 10 to 20 mg/m2 up to 25 mg subcutaneously, on one specified day once weekly methotrexate methotrexate methotrexate
PLUS with either of the above
folic acid 5 mg orally, weekly (not on the same day as methotrexate)2. folic acid folic acid folic acid
Sulfasalazine is effective in children with enthesitis-related arthritis, especially in the management of peripheral joint disease. The usual dose is:
sulfasalazine 5 mg/kg up to 500 mg orally, twice daily, increasing over 2 to 4 weeks to 15 to 20 mg/kg up to 1000 mg twice daily. sulfasalazine sulfasalazine sulfasalazine