TY - JOUR
T1 - Recomendações portuguesas para utilização de metotrexato no tratamento de doenças reumáticas
AU - Canhão, Helena
AU - Santos, Maria José
AU - Costa, Maria Lúcia
AU - Bogas, Mónica
AU - Mourão, Ana Filipa
AU - Machado, Pedro
AU - Fonseca, João Eurico
AU - da Silva, José António Pereira
AU - Cordeiro, Ana
AU - Rodrigues, Ana Maria
AU - Ribeiro, Ana Sofia
AU - Almeida, António Vilar
AU - Faustino, Augusto
AU - Resende, Catarina
AU - Duarte, Cátia
AU - Catita, Cristina
AU - Medeiros, Dina
AU - Godinho, Fátima
AU - Santos, Fernando Alverenga
AU - Santos, Fernando Pimentel
AU - Brandão, Filipe
AU - Munoz, Graça Sequeira
AU - Jesus, Herberto
AU - Branco, Jaime
AU - Ramos, João Carlos
AU - Garcia, Jorge
AU - Silva, Jorge
AU - Pereira Silva, José Alberto
AU - Costa, José António
AU - Gomes, José António Melo
AU - Patto, José Vaz
AU - Inês, Luís Sousa
AU - Coutinho, Margarida
AU - Cruz, Margarida
AU - da Conceição Silva, Maria
AU - Correia, Maria José
AU - Bexiga, Mário
AU - Couto, Maura
AU - Bernardes, Miguel
AU - de Sousa, Miguel Rocha
AU - Nero, Patricia
AU - Rosado-Pinto, Patricia
AU - Araújo, Paula
AU - Santos, Rui André
AU - Silva, Rui Leitão
AU - Falcão, Sandra
AU - Garcês, Sandra
AU - Bravo, Teresa
AU - Tavares, Viviana
AU - Castelão, Walter
PY - 2009/1
Y1 - 2009/1
N2 - Objectives:To develop Portuguese evidence-based recommendations for the use of methotrexate (MTX) in daily clinical practice in rheumatic disorders. Methods:The Portuguese project was integrated in the multinational 3E Initiative (Evidence, Expertise, Exchange) 2007-2008 where a total of 751 rheumatologists from 17 countries have participated. Ten clinical questions concerning the use of MTX in rheumatic diseases were formulated and the Portuguese group added three more questions. A systematic literature search in Medline, Embase, Cochrane Library and 2005-2007 ACR/EULAR meeting abstracts was conducted. Selected articles were systematically reviewed and the evidence was appraised according to the Oxford Levels of Evidence. In Portugal, a national meeting was held in Obidos on February 15 th and 16 th, 2008, involving 50 rheumatologists who discussed and voted by Dephi method the recommendations. Finally, the agreement among the rheumatologists and the potential impact on their clinical practice was assessed. Results: Thirteen national key recommendations on the use of MTX were formulated: work-up before starting MTX, optimal dosage and route of administration, use of folic acid, monitoring, management of hepatotoxicity, long-term safety, mono versus combination therapy, management in the perioperative period, during infections, before/during pregnancy and after clinical remission, screening and treatment of tuberculosis and the role of MTX as a steroid-sparing agent in rheumatic diseases. Discussion: The Portuguese recommendations for the use of MTX in daily clinical practice were developed, which are evidence-based and supported by a panel of 50 rheumatologists, enhancing their validity and practical use. This project was integrated in a multinational initiative that led to the recent publication of ten multinational recommendations which differ from ours in some specific aspects.
AB - Objectives:To develop Portuguese evidence-based recommendations for the use of methotrexate (MTX) in daily clinical practice in rheumatic disorders. Methods:The Portuguese project was integrated in the multinational 3E Initiative (Evidence, Expertise, Exchange) 2007-2008 where a total of 751 rheumatologists from 17 countries have participated. Ten clinical questions concerning the use of MTX in rheumatic diseases were formulated and the Portuguese group added three more questions. A systematic literature search in Medline, Embase, Cochrane Library and 2005-2007 ACR/EULAR meeting abstracts was conducted. Selected articles were systematically reviewed and the evidence was appraised according to the Oxford Levels of Evidence. In Portugal, a national meeting was held in Obidos on February 15 th and 16 th, 2008, involving 50 rheumatologists who discussed and voted by Dephi method the recommendations. Finally, the agreement among the rheumatologists and the potential impact on their clinical practice was assessed. Results: Thirteen national key recommendations on the use of MTX were formulated: work-up before starting MTX, optimal dosage and route of administration, use of folic acid, monitoring, management of hepatotoxicity, long-term safety, mono versus combination therapy, management in the perioperative period, during infections, before/during pregnancy and after clinical remission, screening and treatment of tuberculosis and the role of MTX as a steroid-sparing agent in rheumatic diseases. Discussion: The Portuguese recommendations for the use of MTX in daily clinical practice were developed, which are evidence-based and supported by a panel of 50 rheumatologists, enhancing their validity and practical use. This project was integrated in a multinational initiative that led to the recent publication of ten multinational recommendations which differ from ours in some specific aspects.
KW - Guidelines
KW - Methotrexate
KW - Portugal
KW - Rheumatic Diseases
KW - Rheumatoid Arthritis
UR - http://www.scopus.com/inward/record.url?scp=67649695241&partnerID=8YFLogxK
M3 - Article
C2 - 19377402
AN - SCOPUS:67649695241
SN - 0303-464X
VL - 34
SP - 78
EP - 95
JO - Acta Reumatológica Portuguesa
JF - Acta Reumatológica Portuguesa
IS - 1
ER -
