Efficacy of measles, mumps and rubella revaccination in children with juvenile idiopathic arthritis treated with methotrexate and etanercept

Rheumatology (Oxford). 2009 Feb;48(2):144-8. doi: 10.1093/rheumatology/ken436. Epub 2008 Dec 11.


Objectives: To evaluate the influence of low-dose MTX and etanercept treatment on efficacy of measles, mumps and rubella (MMR) revaccination in children with juvenile idiopathic arthritis.

Methods: A prospective nested case-control study was performed to investigate markers of MMR revaccination induced humoral and cell-mediated immunity in 15 patients with juvenile idiopathic arthritis (ages 6-17 yrs), treated with either low-dose MTX therapy alone or in combination with etanercept. The control group consisted of 22 healthy children. Production of IFN-gamma by T memory cells upon in vitro stimulation with measles, mumps and rubella antigens and seroprevalence of virus-specific IgG antibodies were assessed. Medication use, disease activity and patients' comments on side-effects were observed during the period of 6 months before and after revaccination.

Results: Low-dose MTX therapy following MMR vaccination proved not to hamper T-cell mediated immunity in vitro. Neither low-dose MTX nor etanercept treatment, given simultaneously with revaccination, markedly interfered with generation of long-lived virus-restricted T cells and protective levels of virus-specific IgG antibodies. No increase in disease activity or medication use was seen within 6 months after MMR revaccination, including JIA patients using etanercept. No overt measles, mumps, rubella or secondary severe infections were noted.

Conclusions: Low-dose MTX and etanercept treatment do not seem to interfere with intended outcome of MMR revaccination in children with JIA.

MeSH terms

  • Adolescent
  • Adult
  • Antibodies, Viral / immunology
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Juvenile / drug therapy*
  • Arthritis, Juvenile / immunology
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Drug Therapy, Combination
  • Etanercept
  • Female
  • Humans
  • Immunoglobulin G / immunology
  • Immunoglobulin G / therapeutic use*
  • Infant
  • Interferon-gamma / immunology
  • Male
  • Measles-Mumps-Rubella Vaccine / administration & dosage*
  • Methotrexate / therapeutic use*
  • Prospective Studies
  • Receptors, Tumor Necrosis Factor / therapeutic use*
  • Statistics, Nonparametric
  • T-Lymphocytes / immunology
  • Treatment Outcome
  • Young Adult


  • Antibodies, Viral
  • Antirheumatic Agents
  • Immunoglobulin G
  • Measles-Mumps-Rubella Vaccine
  • Receptors, Tumor Necrosis Factor
  • Interferon-gamma
  • Etanercept
  • Methotrexate