Jon Matthew Farber

When methotrexate (MTX) is administered to patients with juvenile idiopathic arthritis (JIA) using a prefilled pen, the procedure is associated with less pain and fewer side effects than when a conventional prefilled syringe is used, according to a study conducted at a pediatric rheumatology center in Poland.

The 23 patients with JIA, who ranged from 2 to 18 years of age (mean age, 11.7 years) were receiving subcutaneous MTX therapy using a prefilled syringe at the start of the study. After completing a questionnaire evaluating their experience with this device, they began a 1-month period of using the prefilled pen and then completed the same questionnaire to document their experience with the new delivery system. Participants also indicated their overall preference for the pen or syringe. Caregivers completed these questionnaires when they, not the patients themselves, administered the MTX.

Almost 83% of patients or caregivers preferred the prefilled pen to the syringe for administering MTX, citing it as easier to use despite having considerably more experience with the syringe. Moreover, injection with the prefilled pen was considered less painful than with the prefilled syringe. Finally, side effects of MTX were less pronounced after treatment with the prefilled pen, particularly with regard to nausea, vomiting, and abdominal pain (Roszkiewicz, J, et al. 

Articles

Prefilled syringes have been the way that many children with juvenile idiopathic arthritis get their methotrexate. A pilot study examines if prefilled pens might be a better option.

Journal Club: Prefilled Pen to Deliver Methotrexate to Children With JIA

Children with asthma who use a nonsteroidal anti-inflammatory drug (NSAID) during a respiratory infection or no antipyretic at all have a lower risk of experiencing an asthma exacerbation (AE) than asthmatics who use acetaminophen. These were the findings of an analysis of data from a national database in Taiwan related to more than 27,000 children with asthma who had at least one episode of respiratory infection and a similar number of age- and sex-matched non-asthmatic children with respiratory infection who served as controls.

 Participants were divided into 3 groups: acetaminophen use, NSAID cyclooxygenase-1 (COX-1) use, and no antipyretic use. Overall, asthmatic patients used antipyretics less often than controls (48.5% vs 55.5%) with antipyretic users in the asthmatic group tending to be older than nonusers (9.3 vs 7.8 years).

 Investigators compared the rate of AE occurrence within the first 7 days after diagnosis of respiratory infection among the groups and analyzed the risk of AE with adjustments for age, gender, and urbanization level. The overall rate of AE within 7 days of a single respiratory infection episode was low-- about 0.14%, with no observable difference in rate between those who used antipyretics and those who did not. However, the risk of AE was highest in those who took acetaminophen (Chung R-S, et al. 

Acetaminophen may be the antipyretic choice for many families, but a new study asks whether it could be a problem for children with asthma.