Which medication is considered a second-line agent for treating carditis in juvenile idiopathic arthritis?

Methotrexate is recognized as a second-line agent for treating carditis in juvenile idiopathic arthritis because it serves as a disease-modifying antirheumatic drug (DMARD). In cases of juvenile idiopathic arthritis, especially when there are complications like carditis, the management often escalates beyond first-line therapies. Methotrexate effectively reduces inflammation and modulates the immune response, making it particularly useful for patients who do not adequately respond to or cannot tolerate nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids.

In the context of juvenile idiopathic arthritis, first-line treatments typically include NSAIDs such as ibuprofen for pain relief and inflammation reduction, while corticosteroids like prednisone may be used for more rapid control of severe symptoms and systemic complications. However, long-term use of corticosteroids has potential adverse effects, which is why DMARDs like methotrexate are valuable for maintaining disease control over an extended period, especially in cases involving systemic complications like carditis. Thus, methotrexate plays a crucial role in the therapeutic strategy for managing inflammatory processes when initial treatments are insufficient.