The goal of treating juvenile rheumatoid arthritis (JRA) is to minimize discomfort, reduce disability, prevent joint destruction, and maximize physical, intellectual, social, and emotional growth and development. Medications for JRA have previously been limited to aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and slow-acting antirheumatic drugs (SAARDs). However, data regarding the efficacy of SAARDs and the safety and efficacy of immunosuppressive agents in JRA were scant. Thus, use of these medications in children was often guided by data from published studies of adults with rheumatoid arthritis (RA).

In the past 15 years, low-dose methotrexate (MTX) has become widely used for both RA and JRA. Often, MTX was initiated only in children who were refractory to traditional slow-acting agents such as d-penicillamine, hydroxychloroquine, gold salts, and sulfasalazine, or when azathioprine, cyclophosphamide, and chlorambucil were deemed ineffective or too dangerous. Methotrexate for JRA has since been shown to be safe and effective in retrospective studies, in clinical practice, and in controlled trials. It is now often the first agent selected in children with established JRA and is increasingly used in related pediatric rheumatic disorders and other chronic inflammatory conditions.