E x t e n d e d r e p o r t Figure 1 How the patient cohort was derived. DMARD, disease- modifying antirheumatic drug; FU, follow-up; MTX, methotrexate; NOAR, Norfolk Arthritis Register. Figure 2 Outcome of methotrexate (MTX) monotherapy treatment at 1 and 2 years. compliance, patient education and illness beliefs, which may influence treatment response. In summary, routinely gathered clinical and laboratory factors are poor at predicting outcome of treatment with MTX in patients with newly diagnosed inflammatory arthritis. Nevertheless, given the central importance of MTX in the management of RA further work is required to optimise our use of this treatment. Funding: Arthritis Research Campaign UK Competing interests: None. AS’s current address: Arthritis Research Campaign, Chesterfield, UK. REFERENCES 1. Sokka T. Pincus T. Contemporary disease modifying antirheumatic drugs (DMARD) in patients with recent onset rheumatoid arthritis in a US private practice: methotrexate as the anchor drug in 90% and new DMARD in 30% of patients. J Rheumatol 2002;29:2521–4. 2. Bathon JM, Martin RW, Fleischmann RM, Tesser JR, Schiff MH, Keystone EC, et al. A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. N Engl J Med 2000;343:1586–93. 3. Strand V, Cohen S, Schiff M, Weaver A, Fleischmann R, Cannon G, et al. Treatment of active rheumatoid arthritis with leflunomide compared with placebo and methotrexate. Leflunomide Rheumatoid Arthritis Investigators Group. Arch Intern Med 1999;159:2542–50. 4. Kinder AJ, Hassell AB, Brand J, Brownfield A, Grove M, Shadforth MF. The treatment of inflammatory arthritis with methotrexate in clinical practice: treatment duration and incidence of adverse drug reactions. Rheumatology 2005;44:61–6. 5. Aletaha D, Smolen JS. Effectiveness profiles and dose dependent retention of traditional disease modifying antirheumatic drugs for rheumatoid arthritis. An observational study. J Rheumatol 2002;29:1631–8. 6. American College of Rheumatology. Guidelines for the management of rheumatoid arthritis: 2002 update. Arthritis Rheum 2002;46:328–46. 7. Anderson JJ, Wells G, Verhoeven AC, Felson DT. Factors predicting response to treatment in rheumatoid arthritis: the importance of disease duration. Arthritis Rheum 2000;43:22–9. 8. Aletaha D, Smolen JS. The rheumatoid arthritis patient in the clinic: comparing more than 1300 consecutive DMARD courses. Rheumatology 2002;41:1367–74. 9. Hoekstra M, van Ede AE, Haagsma CJ, van de Laar MA, Huizinga TW, Kruijsen MW et al.. Factors associated with toxicity, final dose, and efficacy of methotrexate in patients with rheumatoid arthritis. Ann Rheum Dis 2003;62:423–6. 10. Symmons DP, Barrett EM, Bankhead CR, Scott DG, Silman AJ. The incidence of rheumatoid arthritis in the United Kingdom: results from the Norfolk Arthritis Register. Br J Rheumatol 1994;33:735–9. 11. Kirwan JR, Reeback JS. Stanford Health Assessment Questionnaire modified to assess disability in British patients with rheumatoid arthritis. Br J Rheumatol 1986;25:206–9. 12. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988;31:315–24. 13. Emery P. The Dunlop-Dottridge Lecture: prognosis in inflammatory arthritis: the value of HLA genotyping and the oncological analogy. J Rheumatol 1997;24:1436–42. 14. Sokka T, Kankainen A, Hannonen P. Scores for functional disability in patients with rheumatoid arthritis are correlated at higher levels with pain scores than with radiographic scores. Arthritis Rheum 2000;43:386–9. 15. Wolfe F. A reappraisal of HAQ disability in rheumatoid arthritis. Arthritis Rheum 2000;43:2751–61. 16. O’Dell JR, Nepom BS, Haire C, Gersuk VH, Gaur L, Moore GF, et al. HLA-DRB1 typing in rheumatoid arthritis: predicting response to specific treatments. Ann Rheum Dis 1998;57:209–13. 17. Criswell LA, Lum RF, Turner KN, Peden EA, Means GD, Derry MJ, et al. The HLA- DRB1 shared epitope as a predictor of response to treatment of RA with methotrexate and etanercept. Arthritis and Rheumatism 2002;46(Suppl):376. 18. van Dongen H, van Aken J, Lard LR, Visser K, Ronday HK, Hulsmans HM, et al. Efficacy of methotrexate treatment in patients with probable rheumatoid arthritis: a double-blind, randomized, placebo-controlled trial. Arthritis Rheum 2007;56:1424–32. 19. Ranganathan P, McLeod HL. Methotrexate pharmacogenetics: the first step toward individualized therapy in rheumatoid arthritis. Arthritis Rheum 2006;54:1366–77. 20. Wessels JA, van der Kooij SM, le CS, Kievit W, Barerra P, Allaart CF, et al. A clinical pharmacogenetic model to predict the efficacy of methotrexate monotherapy in recent-onset rheumatoid arthritis. Arthritis Rheum 2007;56:1765–75. 62 Ann Rheum Dis 2009;68:57–62. doi:10.1136/ard.2008.088237