| Methotrexate treatment in rheumatoid arthritis: management in clinical remission, common infection and tuberculosis. Results from a systematic literature review. | |
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MedLine Citation:
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PMID: 20140758 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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This work was performed as part of the Portuguese participation in the 3E Initiative 2007-2008, dedicated to the use of methotrexate (MTX) in rheumatic conditions. Three questions raised by Portuguese rheumatologists and considered relevant to clinical practice remained out of the selection of a set of ten key questions formulated to further establish multinational recommendations on the use of MTX in rheumatic diseases. The authors collected and analyzed all the evidence available by using a systematic literature search methodology and selection criteria concerning the following issues in rheumatoid arthritis (RA): (1) the management of MTX after clinical remission; (2) the management of MTX during infections and (3) the screening and treatment of tuberculosis in patients on MTX treatment. A total of 1,862 references were identified, of which 163 were selected for detailed analysis and 12 included in the final review. The evidence was appraised according to the Oxford Centre for Evidence-based Medicine (EBM) levels of evidence. Although with limited evidence, the authors concluded that: (1) extending the interval for MTX therapy may be a valid alternative regimen in a subset of RA patients in clinical remission (EBM level 2b); (2) MTX may be safe during some common infections in RA patients (EBM level 3b/4); (3) screening and treatment of TB in patients on MTX should be similar to the general population (EBM level 4). The evidence available to support clinical decisions in this area is very limited in number and quality. There is a need for further research and while that is unavailable, practical decisions have to rely on experience and expert opinion. |
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Authors:
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Mónica Bogas; Pedro Machado; Ana Filipa Mourão; Lúcia Costa; Maria José Santos; João Eurico Fonseca; José António P Silva; Helena Canhão |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-02-08 |
Journal Detail:
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Title: Clinical rheumatology Volume: 29 ISSN: 1434-9949 ISO Abbreviation: Clin. Rheumatol. Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-04-27 Completed Date: 2010-07-21 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8211469 Medline TA: Clin Rheumatol Country: Germany |
Other Details:
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Languages: eng Pagination: 629-35 Citation Subset: IM |
Affiliation:
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Division of Rheumatology, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Antirheumatic Agents
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therapeutic use Arthritis, Rheumatoid / complications, drug therapy* Evidence-Based Medicine Humans Infection / complications, diagnosis Methotrexate / therapeutic use* Tuberculosis / complications, diagnosis |
| Chemical | |
Reg. No./Substance:
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0/Antirheumatic Agents; 59-05-2/Methotrexate |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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