We evaluated the therapeutic potential of methotrexate (MTX) in patients with systemic lupus erythematosus (SLE). Their serious disease ruled out further treatment with prednisone or prednisone plus cyclophosphamide. Low dose oral MTX (5-10 mg/week) was added to the therapy (prednisone or prednisone plus cyclophosphamide) of 10 selected patients with SLE. Eight of them showed marked improvement and we were able to taper prednisone and completely discontinue cyclophosphamide therapy. Our results suggest that the use of oral MTX in low, weekly doses can be useful as adjunctive therapy for selected cases of childhood SLE.