Cañete Juan D, Ariza-Ariza Rafael, Bustabad Sagrario, Delgado Concepción, Fernández-Carballido Cristina, García Llorente José Francisco, Loza Estíbaliz, Montilla Carlos, Naranjo Antonio, Pinto José A, Queiro Rubén, Ramírez Julio, Tornero-Molina Jesús
Servicio de Reumatología, Hospital Clínic de Barcelona e IDIBAPS, Barcelona, España.
Departamento de Reumatología, Hospital Universitario Virgen Macarena, Sevilla, España.
Reumatol Clin (Engl Ed). 2018 Jul-Aug;14(4):183-190. doi: 10.1016/j.reuma.2017.08.011. Epub 2017 Oct 17.
To develop recommendations for the management of methotrexate (MTX) in psoriatic arthritis (PsA), based on best evidence and experience.
A group of 12 experts on MTX use was selected. The coordinators formulated 14 questions about the use of MTX in PsA patients (indications, efficacy, safety and cost-effectiveness). A systematic review was conducted to answer the questions. Using this information, inclusion and exclusion criteria were established, as were the search strategies (Medline, EMBASE and the Cochrane Library were searched). Two different reviewers selected the articles. Evidence tables were created. At the same time, European League Against Rheumatism and American College of Rheumatology abstracts were evaluated. Based on this evidence, the coordinators proposed 12 preliminary recommendations that the experts discussed and voted on in a nominal group meeting. The level of evidence and grade of recommendation were established using the Oxford Centre for Evidence Based Medicine and the level of agreement with the Delphi technique (2 rounds). Agreement was established if at least 80% of the experts voted yes (yes/no).
A total of 12 preliminary recommendations on the use of MTX were proposed, 9 of which were accepted. One was included in a different recommendation and another 2 were not voted on and were thereafter clarified in the main text.
These recommendations aim to answer frequent questions and help in decision making strategies when treating PsA patients with MTX.
基于最佳证据和经验，制定银屑病关节炎（PsA）中氨甲蝶呤（MTX）管理的建议。
挑选了一组12位使用MTX的专家。协调人就MTX在PsA患者中的使用提出了14个问题（适应症、疗效、安全性和成本效益）。进行了系统综述以回答这些问题。利用这些信息，制定了纳入和排除标准以及检索策略（检索了Medline、EMBASE和Cochrane图书馆）。两名不同的评审员挑选文章。创建了证据表。同时，对欧洲抗风湿病联盟和美国风湿病学会的摘要进行了评估。基于这些证据，协调人提出了12条初步建议，专家们在一次名义小组会议上进行了讨论和投票。使用牛津循证医学中心的方法以及德尔菲技术（两轮）确定证据水平和推荐等级。如果至少80%的专家投赞成票（是/否），则达成一致。
总共提出了12条关于MTX使用的初步建议，其中9条被接受。一条被纳入另一条建议中，另外2条未进行投票，随后在正文里进行了说明。
这些建议旨在回答常见问题，并在使用MTX治疗PsA患者时帮助制定决策策略。
