This study was designed to evaluate the effects of methotrexate(MTX) therapy plus folate supplementation on the nutritional status of children with juvenile rheumatoid arthritis (JRA). Previous studies using MTX report up to 47% incidence of side effects such as nausea, vomiting, abdominal pain and stomatitis all of which could negatively effect food intake thereby compromising the nutritional status of children. Studies of adults suggest that supplementation with folate during MTX therapy reduces these side effects without decreasing therapeutic effects. No studies have described nutritional status in children receiving MTX and felate.

Fourteen children ages 2.6 years to 18.6 years were included. Indices of nutritional status (anthropometrics, food recalls, and lab tests) were recorded at initiation of MTX and thereafter at 3.6, and 12 months. Nutritional status improved in all children. Only one child experienced a side effect (nausea) which did not decrease food intake. Improved appetites and increased caloric intakes were recorded. Consumption of 75% of the Recommended Dietary Allowances (RDA) for protein, folacin and thiamin was recorded for all children. Three subjects consumed less than 75% of RDA for vitamin A and iron(both of which were evaluated biochemically).

Although a majority of the children were less than the 50th percentile for height and weight at the start of MTX, all improved over the course of 12 months. Improvement in nutritional status of children with JRA(treated with MTX and folate) can be achieved by careful monitoring of food intake, specific laboratory values, selected anthropometrics, and the use of nutritional counseling.