Portuguese recommendations for the use of methotrexate in rheumatic diseases - 2016 update
Authors
Ana Catarina Duarte; Daniela Santos-Faria; Maria João Gonçalves; Alexandre Sepriano; Ana Filipa Mourão; Cátia Duarte; Joana Sousa Neves; Ana Filipa Águeda; Pedro Avila Ribeiro; Alexandra Daniel; Adriano Neto; Ana Cordeiro; Ana Rodrigues; Anabela Barcelos; Cândida Silva; Cristina Ponte; Elsa Vieira-Sousa; Filipa Teixeira; Filipa Oliveira-Ramos; Filipe Araújo; Filipe Barcelos; Helena Canhão; Helena Santos; João Ramos; Joaquim Polido-Pereira; José Tavares-Costa; José António Melo Gomes; Luís Cunha-Miranda; Lúcia Costa; Marcos Cerqueira; Margarida Cruz; Maria José Santos; Miguel Bernardes; Paula Oliveira; Pedro Abreu; Ricardo Figueira; Rita Barros; Sandra Falcão; Patrícia Pinto; Sofia Pimenta; Susana Capela; Vitor Teixeira; João Eurico Fonseca;
Background: Methotrexate (MTX) is the first-line drug in the treatment of rheumatoid arthritis (RA) and the most commonly prescribed disease modifying anti-rheumatic drug. Moreover, it is also used as an adjuvant drug in patients under biologic therapies, enhancing the efficacy of biologic agents.
Objectives: To review the literature and update the Portuguese recommendations for the use of MTX in rheumatic diseases first published in 2009.
Methods: The first Portuguese guidelines for the use of MTX in rheumatic diseases were published in 2009 and were integrated in the multinational 3E Initiative (Evidence Expertise Exchange) project. The Portuguese rheumatologists based on literature evidence and consensus opinion formulated 13 recommendations. At a national meeting, the recommendations included in this document were further discussed and updated. The document resulting from this meeting circulated to all Portuguese rheumatologists, who anonymously voted online on the level of agreement with the updated recommendations.
Results: Results presented in this article are mainly in accordance with previous guidelines, with some new information regarding hepatitis B infection during MTX treatment, pulmonary toxicity monitoring, hepatotoxicity management, association with hematologic neoplasms, combination therapy and tuberculosis screening during treatment.
Conclusion: The present recommendations combine scientific evidence with expert opinion and attained desirable agreement among Portuguese rheumatologists. The regular update of these recommendations is essential in order to keep them a valid and useful tool in daily practice.
Ana Catarina Duarte
Hospital Garcia de Orta, Almada
Daniela Santos-Faria
Unidade Local de Saúde do Alto Minho, Ponte de Lima
Maria João Gonçalves
Hospital de Santa Maria, Centro Hospitalar Lisboa Norte; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon
Alexandre Sepriano
Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon
Ana Filipa Mourão
Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental; CEDOC - Nova Medical School, Universidade Nova de Lisboa; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon
Cátia Duarte
on behalf of the Portuguese Society of Rheumatology
Joana Sousa Neves
on behalf of the Portuguese Society of Rheumatology
Ana Filipa Águeda
on behalf of the Portuguese Society of Rheumatology
Pedro Avila Ribeiro
on behalf of the Portuguese Society of Rheumatology
Alexandra Daniel
on behalf of the Portuguese Society of Rheumatology
Adriano Neto
on behalf of the Portuguese Society of Rheumatology
Ana Cordeiro
on behalf of the Portuguese Society of Rheumatology
Ana Rodrigues
on behalf of the Portuguese Society of Rheumatology
Anabela Barcelos
on behalf of the Portuguese Society of Rheumatology
Cândida Silva
on behalf of the Portuguese Society of Rheumatology
Cristina Ponte
on behalf of the Portuguese Society of Rheumatology
Elsa Vieira-Sousa
on behalf of the Portuguese Society of Rheumatology
Filipa Teixeira
on behalf of the Portuguese Society of Rheumatology
Filipa Oliveira-Ramos
on behalf of the Portuguese Society of Rheumatology
Filipe Araújo
on behalf of the Portuguese Society of Rheumatology
Filipe Barcelos
on behalf of the Portuguese Society of Rheumatology
Helena Canhão
on behalf of the Portuguese Society of Rheumatology
Helena Santos
on behalf of the Portuguese Society of Rheumatology
João Ramos
on behalf of the Portuguese Society of Rheumatology
Joaquim Polido-Pereira
on behalf of the Portuguese Society of Rheumatology
José Tavares-Costa
on behalf of the Portuguese Society of Rheumatology
José António Melo Gomes
on behalf of the Portuguese Society of Rheumatology
Luís Cunha-Miranda
on behalf of the Portuguese Society of Rheumatology
Lúcia Costa
on behalf of the Portuguese Society of Rheumatology
Marcos Cerqueira
on behalf of the Portuguese Society of Rheumatology
Margarida Cruz
on behalf of the Portuguese Society of Rheumatology
Maria José Santos
on behalf of the Portuguese Society of Rheumatology
Miguel Bernardes
on behalf of the Portuguese Society of Rheumatology
Paula Oliveira
on behalf of the Portuguese Society of Rheumatology
Pedro Abreu
on behalf of the Portuguese Society of Rheumatology
Ricardo Figueira
on behalf of the Portuguese Society of Rheumatology
Rita Barros
on behalf of the Portuguese Society of Rheumatology
Sandra Falcão
on behalf of the Portuguese Society of Rheumatology
Patrícia Pinto
on behalf of the Portuguese Society of Rheumatology
Sofia Pimenta
on behalf of the Portuguese Society of Rheumatology
Susana Capela
on behalf of the Portuguese Society of Rheumatology
Vitor Teixeira
on behalf of the Portuguese Society of Rheumatology
João Eurico Fonseca
on behalf of the Portuguese Society of Rheumatology
Hospital Garcia de Orta, Almada
Daniela Santos-Faria
Unidade Local de Saúde do Alto Minho, Ponte de Lima
Maria João Gonçalves
Hospital de Santa Maria, Centro Hospitalar Lisboa Norte; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon
Alexandre Sepriano
Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon
Ana Filipa Mourão
Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental; CEDOC - Nova Medical School, Universidade Nova de Lisboa; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon
Cátia Duarte
on behalf of the Portuguese Society of Rheumatology
Joana Sousa Neves
on behalf of the Portuguese Society of Rheumatology
Ana Filipa Águeda
on behalf of the Portuguese Society of Rheumatology
Pedro Avila Ribeiro
on behalf of the Portuguese Society of Rheumatology
Alexandra Daniel
on behalf of the Portuguese Society of Rheumatology
Adriano Neto
on behalf of the Portuguese Society of Rheumatology
Ana Cordeiro
on behalf of the Portuguese Society of Rheumatology
Ana Rodrigues
on behalf of the Portuguese Society of Rheumatology
Anabela Barcelos
on behalf of the Portuguese Society of Rheumatology
Cândida Silva
on behalf of the Portuguese Society of Rheumatology
Cristina Ponte
on behalf of the Portuguese Society of Rheumatology
Elsa Vieira-Sousa
on behalf of the Portuguese Society of Rheumatology
Filipa Teixeira
on behalf of the Portuguese Society of Rheumatology
Filipa Oliveira-Ramos
on behalf of the Portuguese Society of Rheumatology
Filipe Araújo
on behalf of the Portuguese Society of Rheumatology
Filipe Barcelos
on behalf of the Portuguese Society of Rheumatology
Helena Canhão
on behalf of the Portuguese Society of Rheumatology
Helena Santos
on behalf of the Portuguese Society of Rheumatology
João Ramos
on behalf of the Portuguese Society of Rheumatology
Joaquim Polido-Pereira
on behalf of the Portuguese Society of Rheumatology
José Tavares-Costa
on behalf of the Portuguese Society of Rheumatology
José António Melo Gomes
on behalf of the Portuguese Society of Rheumatology
Luís Cunha-Miranda
on behalf of the Portuguese Society of Rheumatology
Lúcia Costa
on behalf of the Portuguese Society of Rheumatology
Marcos Cerqueira
on behalf of the Portuguese Society of Rheumatology
Margarida Cruz
on behalf of the Portuguese Society of Rheumatology
Maria José Santos
on behalf of the Portuguese Society of Rheumatology
Miguel Bernardes
on behalf of the Portuguese Society of Rheumatology
Paula Oliveira
on behalf of the Portuguese Society of Rheumatology
Pedro Abreu
on behalf of the Portuguese Society of Rheumatology
Ricardo Figueira
on behalf of the Portuguese Society of Rheumatology
Rita Barros
on behalf of the Portuguese Society of Rheumatology
Sandra Falcão
on behalf of the Portuguese Society of Rheumatology
Patrícia Pinto
on behalf of the Portuguese Society of Rheumatology
Sofia Pimenta
on behalf of the Portuguese Society of Rheumatology
Susana Capela
on behalf of the Portuguese Society of Rheumatology
Vitor Teixeira
on behalf of the Portuguese Society of Rheumatology
João Eurico Fonseca
on behalf of the Portuguese Society of Rheumatology
