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Abstract：
OBJECTIVE: Methotrexate is an immunosuppressant commonly used in dermatology. The prevalence of intolerance using the Methotrexate Intolerance Severity Score (MISS) in pediatric juvenile idiopathic arthritis (JIA) ranges from 25% to 75%, but studies in morphea patients are lacking. We sought to determine the prevalence and predictors of methotrexate intolerance in children with morphea compared with children with inflammatory skin diseases and JIA/uveitis.
METHODS: Eligible patients were ages 2 to 18 years and were taking methotrexate for at least 3 months to treat morphea, inflammatory skin disease, or uveitis/JIA. Methotrexate intolerance was calculated using the MISS. A 1-way analysis of variance compared absolute intolerance scores. Multivariate regression analysis was used to compare MISS across diseases and covariates.
RESULTS: Of 48 participants (mean ± SD age, 11.3 ± 4.1 years, 70.8% female), 15 had morphea, 16 had JIA/uveitis, and 17 had inflammatory skin diseases. The overall prevalence of intolerance was 20.8%. Age, sex, duration, and dose did not correlate with overall MISS. The MISS mean ± SD total for oral dosing was 2.5 ± 3.4, compared with 6.78 ± 6.8 for subcutaneous dosing. Patients with JIA/uveitis had the highest prevalence of intolerance (37.5%, n = 6), followed by morphea patients (20%, n = 3) and inflammatory skin disease patients (5.9%, n = 1). The OR of intolerance according to route of administration was 11.2 (95% CI, 2.03-61.89).
CONCLUSIONS: Methotrexate intolerance was highest among patients with JIA/uveitis. The only predictor for risk of intolerance was subcutaneous route of administration. Future work could examine disease activity correlations and interventions designed to minimize intolerance.
METHODS: Eligible patients were ages 2 to 18 years and were taking methotrexate for at least 3 months to treat morphea, inflammatory skin disease, or uveitis/JIA. Methotrexate intolerance was calculated using the MISS. A 1-way analysis of variance compared absolute intolerance scores. Multivariate regression analysis was used to compare MISS across diseases and covariates.
RESULTS: Of 48 participants (mean ± SD age, 11.3 ± 4.1 years, 70.8% female), 15 had morphea, 16 had JIA/uveitis, and 17 had inflammatory skin diseases. The overall prevalence of intolerance was 20.8%. Age, sex, duration, and dose did not correlate with overall MISS. The MISS mean ± SD total for oral dosing was 2.5 ± 3.4, compared with 6.78 ± 6.8 for subcutaneous dosing. Patients with JIA/uveitis had the highest prevalence of intolerance (37.5%, n = 6), followed by morphea patients (20%, n = 3) and inflammatory skin disease patients (5.9%, n = 1). The OR of intolerance according to route of administration was 11.2 (95% CI, 2.03-61.89).
CONCLUSIONS: Methotrexate intolerance was highest among patients with JIA/uveitis. The only predictor for risk of intolerance was subcutaneous route of administration. Future work could examine disease activity correlations and interventions designed to minimize intolerance.
摘要：
目的：甲氨蝶呤是皮肤病学常用的免疫抑制剂。小儿幼年特发性关节炎（JIA）中使用甲氨蝶呤不耐受严重程度评分（MISS）的不耐受发生率为25％至75％。但是缺乏对硬伤患者的研究。我们试图确定与炎症性皮肤病和JIA/葡萄膜炎相比，甲氨蝶呤不耐受的患病率和预测因子。
方法：符合条件的患者年龄为2至18岁，服用甲氨蝶呤至少3个月治疗硬伤，炎症性皮肤病，或葡萄膜炎/JIA。使用MISS计算甲氨蝶呤不耐受。单因素方差分析比较绝对不耐受分数。多因素回归分析用于比较不同疾病和协变量的MISS。
结果：48名参与者（平均年龄±SD，11.3±4.1年，70.8%女性），15岁得了硬皮病,16人患有JIA/葡萄膜炎，17人患有炎症性皮肤病。不耐受的总患病率为20.8%。年龄,性别,持续时间,和剂量与总体MISS无关。口服给药的MISS平均值±SD总计为2.5±3.4,而皮下给药为6.78±6.8。JIA/葡萄膜炎患者的不耐受发生率最高(37.5%,n=6),其次是硬伤患者(20%，n=3）和炎症性皮肤病患者（5.9%，n=1)。根据给药途径，不耐受的OR为11.2（95％CI，2.03-61.89）。
结论：甲氨蝶呤不耐受在JIA/葡萄膜炎患者中最高。不耐受风险的唯一预测因子是皮下给药途径。未来的工作可以检查疾病活动的相关性和旨在最大程度地减少不耐受的干预措施。
方法：符合条件的患者年龄为2至18岁，服用甲氨蝶呤至少3个月治疗硬伤，炎症性皮肤病，或葡萄膜炎/JIA。使用MISS计算甲氨蝶呤不耐受。单因素方差分析比较绝对不耐受分数。多因素回归分析用于比较不同疾病和协变量的MISS。
结果：48名参与者（平均年龄±SD，11.3±4.1年，70.8%女性），15岁得了硬皮病,16人患有JIA/葡萄膜炎，17人患有炎症性皮肤病。不耐受的总患病率为20.8%。年龄,性别,持续时间,和剂量与总体MISS无关。口服给药的MISS平均值±SD总计为2.5±3.4,而皮下给药为6.78±6.8。JIA/葡萄膜炎患者的不耐受发生率最高(37.5%,n=6),其次是硬伤患者(20%，n=3）和炎症性皮肤病患者（5.9%，n=1)。根据给药途径，不耐受的OR为11.2（95％CI，2.03-61.89）。
结论：甲氨蝶呤不耐受在JIA/葡萄膜炎患者中最高。不耐受风险的唯一预测因子是皮下给药途径。未来的工作可以检查疾病活动的相关性和旨在最大程度地减少不耐受的干预措施。
