Drug2nd line
Methotrexate
Folate antagonist; anti-inflammatory via adenosine pathway modulation
- Response rate
- Up to 70%
- Onset
- Weeks to months
- Route
- Oral or SC 7.5-20 mg/week
- Line
- 2nd
- IgM effect
- No direct effect
- Evidence level
- amber
Evidence summary
Most widely used conventional DMARD as steroid-sparing agent. Achieves remission in up to 70% of patients, particularly effective for the chronic articular phenotype. Requires monitoring for hepatotoxicity, which may be exacerbated in AOSD patients with baseline liver dysfunction. Folic acid supplementation recommended.