title: Recommendations for the use of parenteral methotrexate in rheumatic diseases.
abstract: OBJECTIVE
  To develop recommendations for the use of parenteral methotrexate (MTX) in rheumatic diseases, mainly rheumatoid arthritis, based on best evidence and experience.
  
  
  METHODS
  A group of 21 experts on parenteral MTX use was selected. The coordinator formulated 13 questions about parenteral MTX (indications, efficacy, safety and cost-effectiveness). A systematic review was conducted to answer the questions. Using this information, inclusion and exclusion criteria were established, as were the search strategies (involving Medline, EMBASE and the Cochrane Library). Three different reviewers selected the articles. Evidence tables were created. Abstracts from the European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) were evaluated. Based on this evidence, the coordinator proposed preliminary recommendations that the experts discussed and voted in a nominal group meeting. The level of evidence and grade of recommendation were established using the Oxford Center for Evidence-Based Medicine and the level of agreement with the Delphi technique (2 rounds). Agreement was established if at least 80% of the experts voted yes (yes/no).
  
  
  RESULTS
  Most of the evidence involved rheumatoid arthritis. A total of 13 preliminary recommendations on the use of parenteral MTX were proposed; 11 of them were accepted. Two of the 13 were not voted and are commented on in the main text.
  
  
  CONCLUSIONS
  The manuscript aims to solve frequent questions and help in decision-making strategies when treating patients with parenteral MTX.
authors.affiliation: Servicio de Reumatología, Hospital de Guadalajara, Guadalajara, España. Electronic address: jtornero@sescam.org.
authors.forename: Jesús
authors.initials: J
authors.lastname: Tornero Molina
authors.affiliation: Hospital Universitario Araba, Vitoria, España.
authors.forename: Jaime
authors.initials: J
authors.lastname: Calvo Alen
authors.affiliation: Hospital Universitario Central de Asturias, Oviedo, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Ballina
authors.affiliation: Hospital Regional Universitario de Málaga, Málaga, España.
authors.forename: María Ángeles
authors.initials: MÁ
authors.lastname: Belmonte
authors.affiliation: Complexo Hospitalario Universitario A Coruña (CHUAC), La Coruña, España.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Blanco
authors.affiliation: Hospital Universitario Reina Sofía, Córdoba, España.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Caracuel
authors.affiliation: Hospital del Mar, Barcelona, España.
authors.forename: Jordi
authors.initials: J
authors.lastname: Carbonell
authors.affiliation: Hospital de Sant Joan Despí Moisès Broggi, Barcelona, España.
authors.forename: Héctor
authors.initials: H
authors.lastname: Corominas
authors.affiliation: Hospital de Mérida, Badajoz, España.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Chamizo
authors.affiliation: Complejo Asistencial Universitario de Salamanca, Salamanca, España.
authors.forename: Cristina
authors.initials: C
authors.lastname: Hidalgo
authors.affiliation: Hospital Universitari i Politècnic La Fe, Valencia, España.
authors.forename: José Román
authors.initials: JR
authors.lastname: Ivorra
authors.affiliation: Hospital Virgen de Valme, Sevilla, España.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Marenco
authors.affiliation: Hospital Universitari Vall d'Hebron, Barcelona, España.
authors.forename: José Vicente
authors.initials: JV
authors.lastname: Moreno Muelas
authors.affiliation: Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, España.
authors.forename: Santiago
authors.initials: S
authors.lastname: Muñoz-Fernández
authors.affiliation: Hospital Universitari de Bellvitge, Barcelona, España.
authors.forename: Joan M
authors.initials: JM
authors.lastname: Nolla
authors.affiliation: Hospital de León, León, España.
authors.forename: Trinidad
authors.initials: T
authors.lastname: Pérez
authors.affiliation: Hospital Universitari Clínic, Barcelona, España.
authors.forename: Raimon
authors.initials: R
authors.lastname: Sanmarti
authors.affiliation: Hospital Clínico de Valencia, Valencia, España.
authors.forename: Pilar
authors.initials: P
authors.lastname: Trenor
authors.affiliation: Complejo Asistencial de Segovia, Segovia, España.
authors.forename: Claudia
authors.initials: C
authors.lastname: Urrego
authors.affiliation: Servicio de Reumatología, Hospital de Guadalajara, Guadalajara, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Vidal
authors.affiliation: Hospital Marina Alta de la Villajoyosa, Alicante, España.
authors.forename: José
authors.initials: J
authors.lastname: Rosas Gomez de Salazar
mesh_terms: D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D001682:Biological Availability; D000066491:Clinical Decision-Making; D004305:Dose-Response Relationship, Drug; D004333:Drug Administration Routes; D019317:Evidence-Based Medicine; D006801:Humans; D055118:Medication Adherence; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D010353:Patient Education as Topic; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012216:Rheumatic Diseases / Q000188:drug therapy*; D012646:Self Administration
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate
keywords: Enfermedades reumáticas; Methotrexate; Metrotexato; Parenteral; Rheumatic diseases