Low dose methotrexate osteopathy in a patient with polyarticular juvenile idiopathic arthritis

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Abstract
A 36 year old woman presented with severe polyarthralgias lasting for the past two months. She had a 27 year history of polyarticular type JIA, and had received prednisone up to 10 mg/day for the past 25 years. She had no history of osteoporotic or insufficiency fractures. Physical examination showed multiple synovitis of hands, wrists, knees, and ankles. Laboratory investigations showed a slight increase of C reactive protein of 20 mg/l, and a strongly positive rheumatoid factor. Low dose oral MTX was started at an initial weekly dose of 7.5 mg (weight 56 kg, height 156 cm, albumin 42 g/l, serum creatinine 60 μmol/l).