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.
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.
Berends
M A M
MA
Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
de Jong
E M G J
EM
van de Kerkhof
P C M
PC
Gerritsen
M J P
MJ
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
D007166:Immunosuppressive Agents; D008727:Methotrexate