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Paper of the Day- High dose methotrexate cuts RA disability

Intensifying methotrexate early in rheumatoid arthritis increases the chance of remission, say Dutch researchers.

The two year study randomised 299 patients into two groups. The first, conventional treatment group were seen every three months and had their drug doses adjusted according to the clinician's judgement. The second group were given a more intensive treatment approach. They were seen every month to have their MTX dose adjusted using a computerised decision making tool. Symptoms scores were fed into the program which then decided if treatment response was great enough. If not, the dose of methotrexate was increased.
This meant the maximum dose of MTX was reached in just 18 weeks in the intensive treatment versus 52 weeks for those received conventional treatment. Fifty per cent of patients treated intensively had least one remission in two years follow-up compared to 37% in the conventional group (p=0.03).

Ann Rheum Dis 2007;66:1443-1449.

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