Methotrexate for Juvenile Rheumatoid Arthritis

To the Editor: Giannini et al. (April 16 issue) 1 express appropriate concern about balancing efficacy and toxicity in their report of a trial of methotrexate in children with juvenile rheumatoid arthritis. The absence of toxicity over a six-month period is encouraging, but the drug has not been shown to induce remission of the disease, 2 and the prospect of prolonged administration to a growing child evokes concern. Close examination of claims of the drug's efficacy in this report 1 raises questions about the degree of benefit actually observed. Giannini et al. used a number of clinical and laboratory outcome variables. The evidence . . .