Low-dose methotrexate as a steroid-sparing agent in a child with Takayasu's arteritis

Takayasu's arteritis (TA) is a chronic inflammatory arteriopathy affecting the large vessels and has been described predominantly in young adult women. In children it presents as an aggressive disease usually requiring chronic corticosteroid therapy. At present, low dose oral methotrexate (MTX) appears to be an effective steroid-sparing agent in adult patients with active TA. We report a 4-year-old child with Takayasu's arteritis who was initially placed on oral prednisone (2 mg/kg/day) therapy. Three months later, low-dose oral MTX (10 mg/m²/week) was added. Prednisone was successfully tapered over the following year to 0.2 mg/kg every other day. A repeat angiography following 12 months of therapy revealed a dramatic improvement of the vascular lesions. No toxicity was observed with MTX therapy. In conclusion, low-dose oral MTX appeared to be an efficient, safe and steroid-sparing agent in the treatment of a young child with TA.