Austrian Recommendations for the Use of Methotrexate in Rheumatic Disorders Focusing on Rheumatoid Arthritis

Methotrexate (MTX) is commonly used in rheumatological disorders and is the first-line treatment in rheumatoid arthritis. To improve MTX therapy and standardise treatment, recommendations were established on a national basis. An Austrian expert panel retrieved 13 questions by a Delphi process including topics such as workup, monitoring, safety, dosing, pregnancy, surgery as well as pulmonary toxicity, infection and vaccination under MTX treatment. A systematic literature review was performed for each question categorising according to the Oxford level of evidence. On the basis of the evidence 20 Austrian experts discussed the results and formulated recommendations. Finally, internal approval was assessed as well as external validity; the latter was done by an anonymous questionnaire asking practising rheumatologists for their agreement with the recommendations and their practical value. The article summarises the 13 recommendations with the relevant evidence. Additionally we show internal and external agreement with the elaborated recommendations as well as a comparison of the Austrian, German and Multinational 3e recommendations for the use of methotrexate in rheumatic disorders in every day clinical practice.