FRI0614-HPR RECOMMENDATIONS FOR PATIENTS WITH RHEUMATIC DISEASES IN TREATMENT WITH METHOTREXATE
Authors: I. Balaguer Trull, V. Núñez-Monje, I. Torner Hernández, A. Gómez Clari, C. Cano, I. Cánovas Olmos, A. Carbonell Jordá, J. De la Torre-Aboki, M. D. Gil del Gallego, E. Grau García, M. Lorente Betoret, E. Marín Martín, N. Martinez Alberola, C. Nájera Herranz
Journal: Annals of the Rheumatic Diseases (2020)

Background: Methotrexate (MTX) is the first choice disease-modifying anti-rheumatic drug (FAME) in the treatment of rheumatoid arthritis among other rheumatic diseases. It is therefore very important that patients are aware of this treatment and have an adequate management of it. Objectives: The development of a recommendation leaflet for patients with rheumatic diseases in treatment with MTX. Methods: A systematic review of the literature was conducted, defining the criteria for inclusion and exclusion of content. The coordinators of the work generated preliminary recommendations that were evaluated and discussed in GESVR meetings and 10 recommendations on the use of MTX were accepted, which were later ratified by the Valencian Society of Rheumatology. Results: The final document with a brief introduction indicates that MTX can be administered orally or subcutaneously, depending on the prescribed dose and its tolerance. In the case of subcutaneous administration, pre-filled syringes or pens are used which do not require any preparation, so there is no risk of handling and/or inhalation toxicity. The proposed recommendations are described below: [1] MTX should be taken or administered ONLY once a week, and always on the same day of the week. It is important to follow these recommendations to ensure adequate effectiveness and avoid side effects. [2] It is common to add a folic acid supplement the day after MTX is taken to avoid certain side effects of the drug. In some cases it may be necessary to increase the dose to other days of the week. [3] Alcohol consumption should be avoided, as it increases the likelihood of adverse effects from the treatment. [4] Common side effects include nausea or gastrointestinal distress, loss of appetite, headache and fatigue after taking each weekly dose of the drug. If this happens, you can take the daily dose in two doses, avoid taking large amounts and drink plenty of water on the day of administration. If in spite of everything, they do not disappear, you should consult the Rheumatology Unit. [5] It is recommended to use sun protection. [6] Pregnancy and breastfeeding should be avoided while taking MTX. In case of pregnancy desire, you should consult the Rheumatology service in order to schedule a withdrawal of the treatment. In case of unplanned pregnancy, stop treatment and contact the Rheumatology Unit immediately. [7] The annual flu vaccine is recommended. Consultation with the Rheumatology Unit is recommended for additional vaccines. [8] The benefits of MTX take several weeks to appear, so you should not modify or interrupt the treatment on your own. [9] Throughout the treatment, regular tests will be performed to monitor the safety and effectiveness of the drug. [10] In case of doubts, and in case of infection, surgical intervention, oncological pathology or pregnancy, contact the Rheumatology Unit. Conclusion: This leaflet is intended to resolve common doubts of patients receiving treatment with MTX, and thus contribute to improve the therapeutic adherence and avoid errors in the drug taking. Disclosure of Interests: None declared