Recommendations by the Spanish Society of Rheumatology for the management of patients diagnosed with rheumatoid arthritis who cannot be treated with methotrexate.
To establish a set of recommendations for the management of patients diagnosed with rheumatoid arthritis (RA) who cannot be treated with methotrexate (MTX) due to contraindications, drug toxicity or lack of adherence, and to establish therapeutic strategies more effective and safer in these RA patients. A qualitative analysis of the scientific evidence available to June 2015. The 2-round Delphi technique of consensus was used to collect and establish expert opinion based on the participants' clinical experience when only low quality evidence was available. A total of eighteen recommendations were developed for the management of this patient profile. Fourteen of these recommendations were related to drug safety aspects. Recommendations on contraindication and toxicity of MTX have been updated. The experts recommend the use of biological monotherapy, a preferred treatment option, in patients whose profiles reveal a contraindication, intolerance or circumstances that prevent us against the use of MTX. There is some high-quality scientific evidence that supports contraindication and establishes certain conditions of MTX use in RA patients with specific clinical profiles.
Servicio de Reumatología, Hospital Universitario de la Princesa, IIS-IP, Madrid, España.
Rosario
R
García-Vicuña
Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España.
María Auxiliadora
MA
Martín-Martínez
Servicio de Reumatología, Hospital 12 de Octubre, Madrid, España.
María Rosa
MR
Gonzalez-Crespo
Servicio de Reumatología, Hospital Universitario de Guadalajara, Guadalajara, España.
Jesús
J
Tornero-Molina
Servicio de Reumatología, Hospital Universitario Regional de Málaga, Málaga, España.
Antonio
A
Fernández-Nebro
Servicio de Reumatología, Complejo Hospitalario A Coruña, A Coruña, España.
Francisco Javier
FJ
Blanco-García
Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Santander, España.
Ricardo
R
Blanco-Alonso
Servicio de Reumatología, Hospital Universitario Vall d'Hebron, Barcelona, España. Electronic address: smarsal@grr.pcb.ub.cat.
Sara
S
Marsal-Barril
D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D000075203:Contraindications, Drug; D003697:Delphi Technique; D006801:Humans; D055118:Medication Adherence; D008727:Methotrexate / Q000627:therapeutic use*; D036301:Qualitative Research; D013030:Spain
D018501:Antirheumatic Agents; D008727:Methotrexate
Adherencia farmacológica; Anti-rheumatic agents; Artritis reumatoide; Contraindicación; Contraindications; Fármacos antirreumáticos; Medication adherence; Methotrexate; Metotrexato; Rheumatoid arthritis; Toxicidad; Toxicity