Methotrexate is the most often used medication in patients with rheumatoid arthritis (RA). Because of its well-documented efficacy in joint symptoms, methotrexate is also applied to patients with nonorgan threatening disease activity. The value of methotrexate in SLE was recently reviewed by Wong and Esdaile (2005) indicating some benefit in treating active skin and joint disease. Three controlled trials showed a reduction in steroid requirements, but only two studies could also document an improvement in the overall disease activity. One further study found some evidence that methotrexate is more efficacious in patients with no severe activity. However, a conclusive profile for an indication in patients with SLE is not obvious and the risk of accumulation in impaired kidney function and the associated risk of overdose have to be taken into consideration.
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