Recomendações portuguesas para utilização de metotrexato no tratamento de doenças reumáticas

Translated title of the contribution: Portuguese recommendations for the use of methotrexate in the treatment of rheumatoid arthritis

Helena Canhão, Maria José Santos, Maria Lúcia Costa, Mónica Bogas, Ana Filipa Mourão, Pedro Machado, João Eurico Fonseca, José António Pereira da Silva, Ana Cordeiro, Ana Maria Rodrigues, Ana Sofia Ribeiro, António Vilar Almeida, Augusto Faustino, Catarina Resende, Cátia Duarte, Cristina Catita, Dina Medeiros, Fátima Godinho, Fernando Alverenga Santos, Fernando Pimentel SantosFilipe Brandão, Graça Sequeira Munoz, Herberto Jesus, Jaime Branco, João Carlos Ramos, Jorge Garcia, Jorge Silva, José Alberto Pereira Silva, José António Costa, José António Melo Gomes, José Vaz Patto, Luís Sousa Inês, Margarida Coutinho, Margarida Cruz, Maria da Conceição Silva, Maria José Correia, Mário Bexiga, Maura Couto, Miguel Bernardes, Miguel Rocha de Sousa, Patricia Nero, Patricia Rosado-Pinto, Paula Araújo, Rui André Santos, Rui Leitão Silva, Sandra Falcão, Sandra Garcês, Teresa Bravo, Viviana Tavares, Walter Castelão

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)
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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.

Translated title of the contributionPortuguese recommendations for the use of methotrexate in the treatment of rheumatoid arthritis
Original languagePortuguese
Pages (from-to)78-95
Number of pages18
JournalActa Reumatológica Portuguesa
Issue number1
Publication statusPublished - Jan 2009


  • Guidelines
  • Methotrexate
  • Portugal
  • Rheumatic Diseases
  • Rheumatoid Arthritis


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