Evidence-based recommendations for treatment with methotrexate in rheumatic disorders.
BACKGROUND
The aim of this study was to develop 3E (Evidence, Expertise, Exchange) recommendations (RCs) on the use of methotrexate in rheumatic disorders and to assess the agreement among Danish rheumatologists.


METHODS
Based on a systematic literature review and Delphi votes, national and multinational (MN) RCs were developed by 751 rheumatologists from 17 countries including Denmark, and the degree of agreement among the participants was assessed. Subsequently, a survey regarding the agreement on the MN RCs was sent to all Danish rheumatologists.


RESULTS
A total of 24 Danish RCs were elaborated by 43 rheumatologists at a national meeting. 71-100% (median 94%) of the participants agreed with each of the RCs. A total of 73 rheumatologists answered the survey on the ten MN RCs. On numerical rating scales with values ranging from zero to ten, the median agreement score for each of these RCs ranged from eight to ten. The RCs were already applied in daily practice by 70-100% (median 91%) of the specialists. Any direct conflict between the national and MN RCs was not evident.


CONCLUSIONS
Based on evidence and expert opinion in a MN approach, national and MN RCs on methotrexate therapy were developed and a high level of agreement among Danish rheumatologists was evidenced.
Department of Internal Medicine C/Rheumatology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark. rintek@dadlnet.dk
Ole Rintek
OR
Madsen
Mikkel
M
Faurschou
Anne Gitte
AG
Loft
Inge Juul
IJ
Sørensen
John Bonde
JB
Knudsen
Bo
B
Baslund
Annette
A
Hansen
Michael Sejer
MS
Hansen
Mikkel
M
Østergaard
D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D003697:Delphi Technique; D003718:Denmark; D019317:Evidence-Based Medicine; D005260:Female; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D038622:Internationality; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012216:Rheumatic Diseases / Q000188:drug therapy* / Q000473:pathology; D012219:Rheumatology / Q000639:trends; D011795:Surveys and Questionnaires
D018501:Antirheumatic Agents; D008727:Methotrexate