PURPOSE: To evaluate the efficacy of methotrexate (MTX) and the effect of its 
withdrawal on relapse rate of uveitis associated with juvenile idiopathic 
arthritis (JIA).
DESIGN: Retrospective case series.
METHODS: Data of 22 pediatric JIA patients who were being treated with MTX for 
active uveitis were studied retrospectively. Relapse rate after the withdrawal 
of MTX was established. Anterior chamber (AC) inflammation, topical steroid use 
during the first year of MTX treatment, and associations of relapses after the 
withdrawal were evaluated statistically. Duration of MTX treatment and its 
withdrawal was determined individually in collaboration with a rheumatologist 
with an intention to continue the treatment for at least 1 year and to withdraw 
in case of inactivity of uveitis and arthritis. Inactivity of uveitis was 
defined as the presence of ≤0.5+ cells in the AC.
RESULTS: Eighteen patients (18/22; 82%) showed improvement of their uveitis with 
a significant decrease in activity of AC inflammation after a minimal period of 
3 months of MTX treatment. A topical steroid-sparing effect was observed when 
MTX was administered for a period of 3 to 9 months. MTX was discontinued because 
of inactive uveitis in 13 patients. In 9 patients (8/13; 69%) a relapse of 
uveitis was observed after a mean time of 7.5 months (± SD 7.3). Six patients 
(6/13; 46%) had a relapse within the first year after the withdrawal. 
Relapse-free survival after withdrawal of MTX was significantly longer in 
patients who had been treated with MTX for more than 3 years (P = .009), 
children who were older than 8 years at the moment of withdrawal (P = .003), and 
patients who had an inactivity of uveitis of longer than 2 years before 
withdrawal of MTX (P = .033). Longer inactivity under MTX therapy was 
independently protective for relapses after the withdrawal (hazard ratio = 0.07; 
95% confidence interval 0.01-0.86; P = .038), which means that 1-year increase 
of duration of inactive uveitis before the withdrawal of MTX results in a 
decrease of hazard for new relapse of 93%.
CONCLUSIONS: A high number of patients with inactive uveitis relapse quickly 
after the withdrawal of MTX. Our results suggest that a longer period of 
inactivity prior to withdrawal and a longer treatment period with MTX reduce the 
chance of relapse after withdrawal.