Duarte Ana Catarina, Santos-Faria Daniela, Gonçalves Maria João, Sepriano Alexandre, Mourão Ana Filipa, Duarte Cátia, Neves Joana Sousa, Águeda Ana Filipa, Ribeiro Pedro Avila, Daniel Alexandra, Neto Adriano, Cordeiro Ana, Rodrigues Ana, Barcelos Anabela, Silva Cândida, Ponte Cristina, Vieira-Sousa Elsa, Teixeira Filipa, Oliveira-Ramos Filipa, Araújo Filipe, Barcelos Filipe, Canhão Helena, Santos Helena, Ramos João, Polido-Pereira Joaquim, Tavares-Costa José, Melo Gomes José António, Cunha-Miranda Luís, Costa Lúcia, Cerqueira Marcos, Cruz Margarida, Santos Maria José, Bernardes Miguel, Oliveira Paula, Abreu Pedro, Figueira Ricardo, Barros Rita, Falcão Sandra, Pinto Patrícia, Pimenta Sofia, Capela Susana, Teixeira Vitor, Fonseca João Eurico
Hospital Garcia de Orta, Almada.
Unidade Local de Saúde do Alto Minho, Ponte de Lima.
Acta Reumatol Port. 2017 Apr-Jun;42(2):127-140.
Methotrexate (MTX) is the first-line drug in the treatment of rheumatoid arthritis (RA) and the most commonly prescribed disease modifying anti-rheumatic drug. Moreover, it is also used as an adjuvant drug in patients under biologic therapies, enhancing the efficacy of biologic agents.
To review the literature and update the Portuguese recommendations for the use of MTX in rheumatic diseases first published in 2009.
The first Portuguese guidelines for the use of MTX in rheumatic diseases were published in 2009 and were integrated in the multinational 3E Initiative (Evidence Expertise Exchange) project. The Portuguese rheumatologists based on literature evidence and consensus opinion formulated 13 recommendations. At a national meeting, the recommendations included in this document were further discussed and updated. The document resulting from this meeting circulated to all Portuguese rheumatologists, who anonymously voted online on the level of agreement with the updated recommendations.
Results presented in this article are mainly in accordance with previous guidelines, with some new information regarding hepatitis B infection during MTX treatment, pulmonary toxicity monitoring, hepatotoxicity management, association with hematologic neoplasms, combination therapy and tuberculosis screening during treatment.
The present recommendations combine scientific evidence with expert opinion and attained desirable agreement among Portuguese rheumatologists. The regular update of these recommendations is essential in order to keep them a valid and useful tool in daily practice.
甲氨蝶呤（MTX）是治疗类风湿关节炎（RA）的一线药物，也是最常用的改善病情抗风湿药物。此外，它还用作生物治疗患者的辅助药物，可增强生物制剂的疗效。
回顾文献并更新2009年首次发布的葡萄牙关于MTX在风湿性疾病中应用的推荐意见。
葡萄牙关于MTX在风湿性疾病中应用的首个指南于2009年发布，并纳入了多国3E倡议（证据、专业知识、交流）项目。葡萄牙风湿病学家基于文献证据和共识意见制定了13条推荐意见。在一次全国会议上，对本文件中的推荐意见进行了进一步讨论和更新。此次会议形成的文件分发给了所有葡萄牙风湿病学家，他们就对更新后推荐意见的认同程度进行了在线匿名投票。
本文呈现的结果主要与先前的指南一致，有一些关于MTX治疗期间乙肝感染、肺毒性监测、肝毒性管理、与血液系统肿瘤的关联、联合治疗以及治疗期间结核筛查的新信息。
本推荐意见将科学证据与专家意见相结合，在葡萄牙风湿病学家中获得了理想的认同。定期更新这些推荐意见对于使其在日常实践中保持有效和有用的工具至关重要。
