6. Methotrexate is used with other drugs. When methotrexate doesn’t work as well as expected, doctors sometimes add another DMARD such as sulfasalazine (Azulfidine), hydroxychloroquine (Plaquenil), leflunomide (Arava), azathioprine (Imuran), cyclosporine (Neoral) as well as the newer biologic response modifiers (biologics) a subset of DMARDs. While there is less research to support methotrexate combos in children, recent studies have shown benefits of methotrexate in combination with one of several other drugs including etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira) for JA.

7. The injection is “drinkable.” If your child’s doctor has prescribed oral methotrexate and she has trouble swallowing pills, ask the doctor about prescribing the injectable liquid, which can also be taken orally. While the medication has to be measured into a syringe (slightly more work for parents), it goes down easier than a pill – and it costs less.

8. Alcohol is off limits. Taking methotrexate with alcohol increases the risk of liver damage. Although you may not consider this an issue for children, studies show that alcohol use among teens – and even preteens – is prevalent. “Children and teenagers must be warned about the risks,” says Dr. Lehman. “And even then, parents of all children must realize they may be under significant peer pressure to drink.” If you have any reason to suspect your child is drinking, speak to her doctor about a change of medication. 

9. It doesn’t work for all kids. “Probably two-thirds of children with JIA get a significant benefit from methotrexate,” says Dr. Lehman. How do you know if your child will be among those two-thirds – or the approximately one-third that doesn’t get significant benefit? That’s a question researchers are trying to answer, and a recent study offers some clues. 

In a study of 563 children with polyarticular JIA who had been newly treated with methotrexate for six months, researchers compared variables recorded when kids started methotrexate with response to the drug at six months. They found that children who were sick longer before they began methotrexate benefited less from it once they started it. If your child has been on methotrexate for 12 weeks and you haven’t noticed improvement – or if you find the side effects of methotrexate unacceptable – Dr. Lehman advises speaking to your child’s doctor about other treatment options.