Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and young people. For patients who fail to respond to non-steroidal medications, methotrexate (MTX) is the mainstay of treatment. In 2004, the Royal College of Nursing issued guidance for practitioners caring for children receiving MTX for rheumatic conditions, which has since been updated. The drug is now licensed for treatment of JIA using commercially pre-filled syringes, and special training and precautions are no longer necessary. Local practices, policies and procedures should be changed accordingly.