Methotrexate dose rheumatoid arthritis

Therapeutic response usually begins within 3 to 6 weeks and the patient may continue to improve for another 12 weeks or more. Although there is experience with doses up to 30 mg/m2/wk in children, there are too few published data to assess how doses over 20 mg/m2/wk might affect the risk of serious toxicity in children. Limited experience shows a significant increase in the incidence and severity of serious toxic reactions, especially bone marrow suppression, at doses greater than 20 mg/wk in adults. For either adult RA or polyarticular-course JRA dosages may be adjusted gradually to achieve an optimal response. The recommended starting dose is 10 mg/m2 given once weekly. Dose reduction or cessation is guided by patient response and hematologic monitoring.