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Vol. 13. Issue 3.
Pages 127-138 (May - June 2017)
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Vol. 13. Issue 3.
Pages 127-138 (May - June 2017)
Special Article
DOI: 10.1016/j.reumae.2016.10.002
Recommendations by the Spanish Rheumatology Society for the Management of Patients Diagnosed With Rheumatoid Arthritis who Cannot Be Treated With Methotrexate
Documento de Recomendaciones de la Sociedad Española de Reumatología para el manejo clínico del paciente con artritis reumatoide que no puede utilizar metotrexato
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Rosario García-Vicuñaa, María Auxiliadora Martín-Martínezb, María Rosa Gonzalez-Crespoc, Jesús Tornero-Molinad, Antonio Fernández-Nebroe, Francisco Javier Blanco-Garcíaf, Ricardo Blanco-Alonsog, Sara Marsal-Barrilh,
Corresponding author
smarsal@grr.pcb.ub.cat

Corresponding author.
, in representation of the Scientific Committee of the work of Recommendations of the Spanish Society of Rheumatology for the clinical management of the patient with rheumatoid arthritis who cannot use methotrexate
a Servicio de Reumatología, Hospital Universitario de la Princesa, IIS-IP, Madrid, Spain
b Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain
c Servicio de Reumatología, Hospital 12 de Octubre, Madrid, Spain
d Servicio de Reumatología, Hospital Universitario de Guadalajara, Guadalajara, Spain
e Servicio de Reumatología, Hospital Universitario Regional de Málaga, Málaga, Spain
f Servicio de Reumatología, Complejo Hospitalario A Coruña, A Coruña, Spain
g Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
h Servicio de Reumatología, Hospital Universitario Vall d’Hebron, Barcelona, Spain
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Table 1. Recommendations From the Spanish Society of Rheumatology for the Management of Patients With Rheumatoid Arthritis who Cannot Take Methotrexate.
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Abstract

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 18 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.

Keywords:
Rheumatoid arthritis
Methotrexate
Contraindications
Toxicity
Medication adherence
Anti-rheumatic agents
Resumen

El objetivo es establecer recomendaciones para el manejo del paciente con artritis reumatoide (AR) que no puede utilizar metotrexato (MTX) por contraindicación, toxicidad o falta de adherencia farmacológica, y establecer las estrategias terapéuticas más eficaces y seguras. Se realizó un análisis cualitativo de la evidencia científica disponible hasta junio de 2015. Se utilizó un Delphi con un panel de 17 reumatólogos para consolidar la opinión de expertos en aquellas recomendaciones con ausencia o baja calidad científica.

Se elaboraron 18 recomendaciones, y 14 de ellas abordan aspectos de seguridad. Se han actualizado las recomendaciones sobre la contraindicación del MTX y su toxicidad, y se recomienda como una opción terapéutica preferente la utilización de monoterapia biológica en pacientes con contraindicación, intolerancia o circunstancias que desaconsejan el uso de MTX. Existe evidencia científica de buena calidad que contraindica y extrema la utilización de MTX en pacientes con AR con determinados perfiles clínicos.

Palabras clave:
Artritis reumatoide
Metotrexato
Contraindicación
Toxicidad
Adherencia farmacológica
Fármacos antirreumáticos

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