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Methotrexate and psoriasis: 2009 National Psoriasis Foundation Consensus Conference

      Background

      Methotrexate remains a valuable option for the treatment of psoriasis. This report will summarize studies regarding the use of methotrexate since the last guidelines were published in 1998.

      Objective

      A task force of the National Psoriasis Foundation Medical Board was convened to evaluate treatment options. Our aim was to achieve a consensus on new updated guidelines for the use of methotrexate in the treatment of psoriasis.

      Methods

      Reports in the literature were reviewed regarding methotrexate therapy.

      Results

      A consensus was achieved on use of methotrexate in psoriasis including specific recommendations on dosing and monitoring. The consensus received unanimous approval from members of the Medical Board of the National Psoriasis Foundation.

      Limitations

      There are few evidence-based studies on the treatment of psoriasis with methotrexate. Many of the reviewed reports are for the treatment of rheumatoid arthritis.

      Conclusions

      Methotrexate is a safe and effective drug for the treatment of psoriasis. Appropriate patient selection and monitoring will significantly decrease the risks of side effects. In patients without risk factors for hepatic fibrosis, liver biopsies may not be indicated or the frequency of liver biopsies may be markedly reduced.

      Abbreviations used:

      ACR (American College of Rheumatology), ALT (alanine aminotransferase), AST (aspartate aminotransferase), CDC (Centers for Disease Control and Prevention), FDA (Food and Drug Administration), NASH (nonalcoholic steatohepatitis), NSAID (nonsteroidal anti-inflammatory drug), PASI (Psoriasis Area and Severity Index), PIIINP (aminoterminal peptide of procollagen III), PPD (purified protein derivative), PUVA (psoralen plus ultraviolet A)
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      Linked Article

      • Methotrexate guidelines 2009?
        Journal of the American Academy of DermatologyVol. 63Issue 2
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          To the Editor: The article by Kalb et al1 in the May 2009 issue of the Journal was prepared as an update of previous methotrexate guidelines.2-5 Three of the original four authors (H.R., H.M., and R.A.) of previous methotrexate guidelines were not consulted in the 2009 update. Why have the guidelines changed from a function of the American Academy of Dermatology (AAD) to the National Psoriasis Foundation (NSF)? A recent member alert (June 22, 2009) from the AAD, requested “member review and comment on the fourth section of newly developed evidenced based Guidelines of Care for the Management and Treatment of Psoriasis.” The Psoriasis Expert Work Group of AAD includes some of the authors of the NSF Methotrexate and Psoriasis 2009 publication.
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      • Response to the letter to editor re: “Methotrexate and psoriasis: Consensus conference”
        Journal of the American Academy of DermatologyVol. 66Issue 4
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          To the Editor: I read with interest the recent letter to the editor by Kalb et al,1 responding to an earlier letter by Roenigk et al2 on “Methotrexate and psoriasis: 2009 National Psoriasis Foundation Consensus Conference.”3
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