title: Dermatologists' adherence to the guideline of the Dutch Society of Dermatology and Venereology with respect to the treatment with methotrexate for severe chronic plaque psoriasis: results from a Dutch survey.
abstract: BACKGROUND
  In 2003, the Dutch guideline 'Photo(chemo) therapy and systemic therapy for severe chronic plaque psoriasis' was established.
  
  
  OBJECTIVE
  To document how closely this guideline is followed in clinical practice with respect to the methotrexate (MTX) treatment and to formulate recommendations to adjust the guideline.
  
  
  METHODS
  A survey was conducted among Dutch dermatologists and residents in dermatology. The questionnaire assessed the knowledge of and the adherence to the guideline with respect to MTX treatment.
  
  
  RESULTS
  Fifty percent of the contacted dermatologists/residents responded. Fifty-two percent follow the guideline with respect to MTX. Liver biopsy and the frequency of blood investigations cause a discrepancy between guideline and reality. There is a lack of consensus between guidelines of the different specialisms concerning liver biopsy.
  
  
  CONCLUSIONS
  The need for liver biopsies in combination with the frequent check-ups and the lack of consensus between rheumatologists, hepatologists and dermatologists seem to restrict the adherence to the guideline.
authors.affiliation: Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: M A M
authors.initials: MA
authors.lastname: Berends
authors.forename: E M G J
authors.initials: EM
authors.lastname: de Jong
authors.forename: P C M
authors.initials: PC
authors.lastname: van de Kerkhof
authors.forename: M J P
authors.initials: MJ
authors.lastname: Gerritsen
mesh_terms: D000328:Adult; D003880:Dermatology / Q000592:standards / Q000639:trends; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011565:Psoriasis / Q000188:drug therapy* / Q000473:pathology*; D011787:Quality of Health Care; D012720:Severity of Illness Index; D012955:Societies, Medical; D011795:Surveys and Questionnaires
chemical_list: D007166:Immunosuppressive Agents; D008727:Methotrexate