Recommendations Differ on Methotrexate Use to Treat Rheumatoid Arthritis

Recommendations guiding the use of methotrexate in patients with rheumatoid arthritis agree on some key points but differ on others, according to a systematic review published in the journal Clinical Rheumatology.

“Most recommendations for the use of methotrexate in rheumatoid arthritis are issued by developed countries. It is unknown whether they are relevant globally,” wrote an international research team. “We reviewed existing recommendations on the use of methotrexate for the treatment of rheumatoid arthritis and summarized areas of agreement that could be relevant for least developed countries.”

Researchers screened 25 full-text studies and included 12 of them in a narrative synthesis of the most current methotrexate recommendations.

According to the review, 83.3% of the recommendations covered methotrexate prescribing, 66.7% covered special considerations such as perioperative management, 58% addressed assessment of the patient before methotrexate prescribing, and 50% discussed management of methotrexate side effects.

The guidelines agreed on baseline tests before starting methotrexate, toxicity monitoring, and the need for folic acid supplementation, researchers reported. They disagreed, however, on the appropriate starting dose, maximal dose, optimal route, titration, and frequency of assessments to monitor toxicity.

“Existing recommendations do not uniformly address all aspects related to the use of methotrexate and disagree in relevant aspects of methotrexate use,” researchers concluded. “Adaptations to these recommendations are needed to facilitate their implementation in least developed countries.”

—Jolynn Tumolo

Reference:

Valerio V, Kwok M, Loewen H, et al. Systematic review of recommendations on the use of methotrexate in rheumatoid arthritis. Clinical Rheumatology. 2021;40(4):1259-1271.