title: Adherence to current recommendations on the use of methotrexate in rheumatoid arthritis in Italy: results from the MARI study.
abstract: OBJECTIVE
  The aim of this study was to assess how the management of rheumatoid arthritis (RA) with methotrexate (MTX) in Italy is adherent to current national recommendations.
  
  
  METHODS
  We performed a cross-sectional and retrospective analysis of data collected from the MARI study, a multicentre survey on Italian patients with RA on treatment with MTX for at least 12 months. Retrospective data included patient's clinical history, previous treatment with MTX, screening tests performed before MTX prescription. Cross-sectional data were collected about current treatment with MTX, concomitant medications, and disease activity. Each proposition of the 2013 Italian recommendations on the use of MTX in RA was reformulated in terms of audit criteria, and adherence to provided indications was evaluated for every patient.
  
  
  RESULTS
  Among the 1336 included patients, less than 40% had started treatment with MTX within 3-6 months from the diagnosis and nearly 30% of them were prescribed with an initial dose of MTX between 12.5 and 15 mg/week. Screening for HBV and HCV infection as well as chest x-ray was performed in a proportion of patients around 60% and more than 90% of them underwent lab tests before MTX prescription and regularly throughout the treatment. Folic acid supplementation was given at recommended dosages in a high proportion of patients.
  
  
  CONCLUSIONS
  Our survey showed a good adherence of Italian rheumatologists to recommendations regarding safety issues with MTX in RA, but a suboptimal approach in terms of time and dosage of the treatment in the early phases of the disease.
authors.affiliation: Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milano, Italy. maria.manara@gmail.com.
authors.forename: Maria
authors.initials: M
authors.lastname: Manara
authors.affiliation: Department of Rheumatology, ASL3, Azienda Sanitaria Genovese, Genova, Italy.
authors.forename: Gerolamo
authors.initials: G
authors.lastname: Bianchi
authors.affiliation: Rheumatology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Bruschi
authors.affiliation: Department of Rheumatology, ASL TO4, Ospedale di Ivrea, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Azzolini
authors.affiliation: Department of Rheumatology, Azienda ICP Milano, presidio Ospedaliero E. Bassini, Milano, Italy.
authors.forename: Nebiat
authors.initials: N
authors.lastname: Belai Beyene
authors.affiliation: Department of Internal Medicine, O.C. di Vittorio Veneto, Vittorio Veneto, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Corbanese
authors.affiliation: Department of Internal Medicine, Azienda Ospedaliera Istituti Ospitalieri di Cremona, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: De Gennaro
authors.affiliation: Department of Internal Medicine, Ospedale Regina Apostolorum, Albano Laziale, Italy.
authors.forename: Luis S
authors.initials: LS
authors.lastname: Martin-Martin
authors.affiliation: Department of Rheumatology, Azienda Ospedaliera Ospedali Riuniti Papardo-Piemonte di Messina, Messina, Italy.
authors.forename: Aldo B
authors.initials: AB
authors.lastname: Molica Colella
authors.affiliation: Department of Internal Medicine, AO San Gerardo Monza, Università Milano-Bicocca, Monza, Italy.
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Pozzi
authors.affiliation: Department of Rheumatology, ASO Santa Croce e Carle, Cuneo, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Romeo
authors.affiliation: Department of Internal Medicine, Ospedale Valduce, Como, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Rossini
authors.affiliation: Department of Allergology and Clinical Immunology, IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Italy.
authors.forename: Adriana
authors.initials: A
authors.lastname: Severino
authors.affiliation: Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milano, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Sinigaglia
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D054539:Medication Therapy Management / Q000706:statistics & numerical data; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D061665:Time-to-Treatment
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate