Methotrexate NICE guidelines

Save on Methotrexate - Official GoodRx® Sit

Print your Methotrexate coupon instantly or just bring it to the pharmacy on your phone. No commitment or fees to use GoodRx. It's simple to start saving today at the pharmacy MTX is usually prescribed as a once a week treatment. Folic acid is routinely co-prescribed with methotrexate in order to reduce adverse effects and toxicity (folic acid is usually taken on a 'non-methotrexate' day). For information on when to refer people on MTX, see the section on when to refer. Table 8

Treatment of Alopecia Areata: Overview

Scenario: Methotrexate Management DMARDs CKS NIC

  1. 24 April 2013. Everything NICE has said on managing rheumatoid arthritis in adults in an interactive flowchart. Type: Guidance (Add filter) Show result download options. Click export CSV or RIS to download the entire page of results or use the checkbox in each result to select a subset of records to download. Export a CSV file. Export a RIS file
  2. istration), which has resulted in some fatalities
  3. imise it
  4. Methotrexate is a high-risk drug requiring robust and safe pathways for monitoring and prescribing as identified in national alerts
  5. The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the safe and effective use of methotrexate (MTX) in children and adults and its extensive on- and off-label applications for inflammatory dermatoses only
  6. Clinical experience of methotrexate in Crohn's disease: response, safety and monitoring of treatment. Source: Medicines Management Collection (Add filter) Published by Postgraduate Medical Journal, 08 April 2010. Background: Methotrexate is an immunosuppressant used in the treatment of patients with Crohn's disease who are intolerant or.

Prescribe as recommended by the specialist. Ensure continued prescribing of methotrexate remains clinically appropriate at dose advised by initiating team. The primary care prescribers will be asked to take up the monitoring and prescribing of methotrexate around 8 weeks after it has been initiated NICE has also produced technology appraisal guidance on drug treatment for rheumatoid arthritis. In October 2020, we amended the 'treat to target' recommendations to clarify that multiple disease-modifying anti-rheumatic drugs can be offered one after the other to achieve treatment targets Methotrexate is administered once weekly as a single dose or in divided doses given over a 24-hour period. To reduce the incidence of major toxic effects, methotrexate should never be given in.. Methotrexate is an abortifacient as well as teratogenic. The drug must be stopped in both male and females for least 4 months prior to conceiving. Alcohol consumption must be kept well within the national recommendations i.e. 14 units per week. However these units must be spaced out during the whole week NICE has accredited the process used by the British Association of Dermatologists to produce guidelines. Accreditation is valid for ogy, make such guidelines timely. 6.1 Methotrexate metabolism and possible mechanism of action The exact mechanism of action of MTX in inflammatory der

NICE related to guidance) NICE clinical guideline 154. Diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage. December 2012. If Yes - does the strategy/policy deviate from the recommendations of NICE? If so, why? No Guideline for the Medical Management of Ectopic Pregnancy with Methotrexate NICE has renewed accreditation of the process used by the British Association of Dermatologists to produce clinical guidelines. The accreditation recognises the stringent protocol that the BAD employs in producing clinical guidelines Both methotrexate and fluorouracil can increase the risk of myelosuppression. Both methotrexate and fluorouracil can increase the risk of thromboembolism. Methotrexate potentially increases the risk of severe skin reaction when given with topical fluorouracil. Manufacturer makes no recommendation Methotrexate oral shared care protocol rheumatology Page 1 of 7 SHARED CARE GUIDELINE Methotrexate for use in Rheumatology Implementation Date: 1st December 2019 Review Date: 1st December Patients with CKD should be graded as per NICE definition of CKD (table 1) and have IA dose reductions as per recommendations by the.

methotrexate shared care guidelines - Evidence search NIC

METHOTREXATE Drug BNF content published by NIC

Methotrexate (MTX) has been used in the treatment of psoriasis and other dermatological diseases for more than 50 years. However, there is limited evidence regarding its effect, dose and monitoring, and a lack of consensus regarding how the drug should be used in daily practice Methotrexate tablets 2.5mg ONLY (Methotrexate tablets 10mg - are NOT recommended as per NPSA guidance5). Dosages and route of administration Methotrexate is given orally once per week. The patient is advised to take the treatment on the same day each week and the day of the week is defined in the NPSA booklet to avoid confusion Oral methotrexate products with indications requiring once-weekly dosing will come with a patient card (July 2020), which will prompt patients to take methotrexate once a week and to record the. Methotrexate is a medicine used to treat a variety of cancers and autoimmune conditions. Acute renal dysfunction (kidney injury) is a life-threatening complication that can occur with high doses of methotrexate. When this occurs large amounts of methotrexate remain in the blood causing the side effects that have a high risk of death Methotrexate Package Insert; NICE Guidelines: Rheumatoid arthritis in adults: management; Concomitant use of low-dose methotrexate and NSAIDs and the risk of serious adverse events among patients with rheumatoid arthritis. PubMed; American College of Rheumatology Guidelines. PubMe

Shared Care Guideline Prescribing and Monitoring of oral METHOTREXATE in adults Licensed and off-label indications . Dear GP, Progressing to a stable, optimal dose usually takes about three months. Once achieved, a Shared Care arrangement withyou will be requested. It will clarify responsibilities between thespecial ist and general. NICE has released its 2019 guidelines on diagnosis and initial management of Ectopic pregnancy and miscarriage. This guideline covers diagnosing and managing tubal ectopic pregnancy and miscarriage in women with complications, such as pain and bleeding, in early pregnancy (that is, up to 13 completed weeks of pregnancy)

Methotrexate is favoured because studies have shown that early tight control of arthritis symptoms using this drug can significantly reduce disease activity. 6 Methotrexate is known to cause pneumonitis and so all patients should View the Guidelines summary of the NICE guideline on Rheumatoid arthritis: the management of rheumatoid. Rheumatology Department DMARD Monitoring Guidelines for Methotrexate Indications Licenced for RA and Psoriasis. Also prescribed for Psoriatic Arthritis, Crohns disease, connective tissue disease (SLE, myositis and vasculitis), Felty's syndrome. Dose Typical dose 7.5mg-25mg once weekly. Initial dose is usually 15mg once weekly Methotrexate Oral Shared Care Guidelines. The oral methotrexate shared care guideline is available in two different versions (adult and paediatric). Please ensure you select the correct document from the links below: There are also separate shared care guidelines for the subcutaneous formulation of methotrexate which can be found by clicking here Methotrexate can cause dizziness, fatigue, blurred vision and eye-irritation, which may affect the ability to drive or operate machinery. References 1. Summary of Product Characteristics Maxtrex (Wyeth) / Methotrexate (Mayne Pharma) January 2006. 2. British Society of Rheumatologists Guidelines August 2000. 3 # Marked recovery of CFS symptoms during methotrexate treatment The NICE Guidelines are biased publications based on the GOBSART (Good Old Boys Sitting Around a Table) approach. This Blog however is not only evidence based but also uses critical reading to judge papers and articles

Psoriasis: assessment and management NIC

1. The National Patient Safety Agency. Improving compliance with oral methotrexate guidelines. NPSA/2006/13. June 2006 2. NPSA: Towards the safer use of Methotrexate NPSA 2004 3. UKMi: In Use Product Safety Assessment Report for Methotrexate pre-filled devices. Nov 2017 4. NHS Improvement Never Events List 201 Guideline on prescribing drugs in pregnancy and breastfeeding Part 1: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. 2016 NICE-accredited. In revision. Guideline scope. 2016 guideline. Executive summary. Full guideline. Audit tool. Podcas The areas the guideline does not cover. This guideline does not cover the indications for DMARD therapy or the use of biologic therapy and other selective non-biologic DMARDs (e.g. kinase inhibitors). The guideline also does not cover prescribing in relation to pregnancy because this is covered by an existing guideline [2, 3] Introduction. Methotrexate is an antimetabolite that interferes with the metabolism of folic acid. After entry into the cell, methotrexate is polyglutamated, binds dihydrofolate reductase (DHFR) with an affinity 1,000-fold greater than that of folate, and competitively inhibits conversion of dihydrofolate to tetrahydrofolate ().Tetrahydrofolate is essential for biosynthesis of thymidine and.

Applying the principles of PINCER to learn from - NIC

Published: 04/11/2016. Diagnosis and Management of Ectopic Pregnancy (Green-top Guideline No. 21) This guideline provides evidence-based guidance on the diagnosis and management of ectopic pregnancies. You can also access this guideline in PDF. This guideline replaces The Management of Tubal Pregnancy, which was published in 2004 In line with NICE recommendations from guidelines on the management of early pregnancy complications and RCOG study groups, 1, 182 women with suspected ectopic pregnancy should be managed in dedicated early pregnancy clinics OBJECTIVE To evaluate methotrexate treatment in patients with active adult onset Still's disease (AOSD). METHODS Methotrexate was initially given as a single weekly oral dose of 5 mg and adjusted individually afterwards in 13 patients with active AOSD. Symptoms and laboratory findings were investigated. RESULTS Signs of AOSD activity disappeared (remission) in eight patients between 3 and 16. Methotrexate usually shows some benefit in responding skin diseases within 6 to 8 weeks. Maximum effects are generally achieved within 5 to 6 months, depending on dose escalation. In chronic plaque psoriasis, about 50-70% of patients see a good result (a reduction in PASI score of 75%). To measure a PASI score, see also Patient-oriented. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Data sources include IBM Watson Micromedex (updated 1 July 2021), Cerner Multum™ (updated 1 July 2021), ASHP (updated 30 June.

British Association of Dermatologists' guidelines for the

2. Guidelines 2.1 Background Methotrexate remains one of the most effective (non-biologic) Disease Modifying Anti-Rheumatic Drugs (DMARD) for rheumatoid arthritis available today (Bijlsma, 2012 cited in RCN, 2013) and its use is seen as a gold standard treatment for rheumatoid conditions (NICE 2009, BSPAR, 2010 cited in RCN, 2013) Weekly methotrexate tablets . Information to read before you start treatment . This information sheet has been given to you to help answer some of the questions you may have about methotrexate. It is in addition to the information found in the leaflet inside the tablet packet. Please make sure you read both leaflets carefully Methotrexate can cause serious or fatal side effects. Tell your doctor if you have diarrhea , mouth sores, cough, shortness of breath, upper stomach pain, dark urine, numbness or tingling, muscle weakness, confusion, seizure, or skin rash that spreads and causes blistering and peeling Methotrexate (MTX) is one of the most commonly used drugs for the treatment of PsA, yet there is scant controlled trial data to document its efficacy. Psoriatic arthritis (PsA) is a form of inflammatory arthritis that occurs in patients with psoriasis and is distinct from rheumatoid arthritis (RA)

Methotrexate. Oral methotrexate is a safe and effective medication if taken at the right dose. and with appropriate monitoring. However, the NPSA's patient safety alert highlighted very occasional problems with taking the medication that resulted in serious harm and even death. As a result, all NHS organisations (including NHS foundation. Methotrexate, either peroral or parenteral, Following the NICE guidance , a mean probabilistic sensitivity analysis result (€4742/QALY) is also presented as a base-case cost-effectiveness result in Table 3. A cost-effectiveness scatter plot is presented in Fig. 3 and a cost-effectiveness acceptability curve in Fig. 4 NICE guidelines aim to help resolve uncertainty about which treatments represent the best quality care and the best value for money for the NHS. NICE acknowledge that loss in early pregnancy accounts for over 50,000 hospital admissions in the UK annually and that the rate of ectopic pregnancy is 11 per 1000 pregnancies methotrexate, as it can cause side effects which may mean the medication needs to be stopped or the dose changed. Methotrexate is a drug used outside of its normal licence (for chemotherapy at higher doses) for children under 16 years of age with inflammatory disease. For more information, please as

Guidance on Self-Injecting Methotrexate for the Treatment of Arthritis Download . Self-injecting methotrexate Watch Video . Pregnancy Prescribing Information. Medications and Pregnancy- Rheumatoid Arthritis. Information for women and men with rheumatoid arthritis thinking about starting a family 1.1 Scope of the Guidance While there are a number of existing guidelines for the treatment of dental patients taking warfarin 2-4 or aspirin4,5, national dental clinical practice guidelines addressing the newer medications are lacking.6 This guidance aims to encourage a consistent approach to the management of denta NICE guideline COVID-19 rapid guideline on dermatological conditions. 2021-04-13T13:49:00Z. The purpose of this Guidelines summary is to maximise the safety of children and adults who have dermatological conditions treated with drugs affecting the immune response during the COVID-19 pandemi methotrexate in patients with a history of alcohol abuse, but do not specify any restrictions to alcohol consumption in patients taking methotrexate (25). By contrast, the American College of Rheumatology (ACR) guidelines take a cautious approach similar to the manu-facturers and advise that alcohol should be avoided whilst on methotrexate (26)


methotrexate [meth-oh-TREK-seyt] or through surgery. When an ectopic pregnancy is discovered early (during the first 6 weeks) in the pregnancy and certain hormone levels are low, your healthcare provider will probably recommend methotrexate. How does methotrexate work? Methotrexate works by stopping the growth of th A number of studies evaluated the efficacy of methotrexate as second-line treatment for sarcoidosis, and showed that methotrexate had a significant steroid-sparing effect and improved pulmonary function [13,14,15,16] . Most commonly reported side-effects in these studies were gastro-intestinal complaints, headache, general malaise and infections

This guideline is related to guideline 'Pain and Bleeding in Early Pregnancy'. 2. Definitions Ectopic pregnancy is a pregnancy that is not located in the uterus. The fertilized egg has settled in a location other than the endometrium. The large majority (95%) of ectopic pregnancies occur in the fallopian tube BSPAR Guidelines. This section includes documents that you may find useful in your clinical practice. BSPAR statement on TNF malignant disease and infection Apr 2011 profession.pdf. BSPAR guidance for Autologous Haematopoietic Stem Cell Rescue 2011.pdf. BSPAR Guidelines for Eye Screening 2006.pdf Various guidelines for the use of methotrexate in psoriasis have been published. 32,38-43 The 2009 American guidelines stratify patients into low or high risk based on risk factors (eg, metabolic syndrome, alcohol consumptions, and pre-existing liver disease). 39 No baseline liver biopsy is advised for low-risk patients. For this group, liver.

methotrexate monitoring Search results page 1 - NIC

Understanding methotrexate and rheumatoid arthritis (RA) Rheumatoid arthritis (RA) is a chronic condition that causes inflamed joints with pain, swelling, stiffness, and reduced range of motion. For methotrexate injections, the dose advised by NICE (National Institute of Health and Care Excellence) to bring on remission in Crohn's Disease is weekly injections of 25mg. The maintenance dose (to keep you in remission) which is advised by NICE is weekly injections of 15mg The American College of Emergency Physicians and the American College of Obstetricians and Gynecologists have issued guidelines for using ultrasonography and beta-hCG levels to evaluate patients. Date reviewed: April 2021 Yes Yes No Sarilumab • No • No No Derbyshire commissioning guidance on biologic drugs for the treatment of severe Rheumatoid arthritis without methotrexate This algorithm is a tool to aid the implementation of NICE guidance on biologic drugs for the treatment of rheumatoid arthritis

Patients with invasive early breast cancer should now undergo dual energy X-ray absorptiometry scans, if starting adjuvant aromatase inhibitors or undergoing ovarian ablation/suppression therapy, according to NICE.2 For patients with advanced breast cancer, the new guidelines suggest that endocrine therapy should be offered for most patients with oestrogen receptor-positive disease.3 Also. This document incorporates and summarises information from a number of publications, including guidelines published by the National Institute for Health and Care Excellence (NICE) [1,4], UpToDate [2,7,10,16,17,23,26] and the NZ Formulary [20,22]. It is relevant to the treatment of psoriasis in New Zealand. In this guideline, psoriasis refers to.

  1. New Rheumatoid Arthritis Guidelines in the Works for 2015. BOSTON — An American College of Rheumatology (ACR) panel is working on new rheumatoid arthritis guidelines that will include first-time.
  2. The evidence for an interaction between methotrexate and penicillins is limited to case reports and animal studies. So far, there is no conclusive evidence tha
  3. For the first time, biologics have been recommended for the treatment of moderate rheumatoid arthritis (RA) in final draft guidance from the National Institute for Health and Care Excellence (NICE). The guidance, which was published on 10 June 2021, says that adalimumab, etanercept and infliximab, all taken with methotrexate, are recommended for use within the [
  4. Early pregnancy problems are thought to lead to over 500 000 visits and about 50 000 admissions to UK hospitals annually. The emotional cost to women and their partners is considerable, and both miscarriage and ectopic pregnancy (EP) are associated with significant morbidity and even mortality. In 2013, a National Institute for Health and Care Excellence (NICE) guideline was produced on the.
  5. istration of Intravenous High-Dose Methotrexate Regimen for ad

Rheumatoid arthritis in adults: management - NIC

and initialmanagementin early pregnancy of ectopic pregnancy and miscarriage. NICE Clinical Guidelines. 2012:1-287. 4. Stika C. Methotrexate: The Pharmacology Behind Medical Treatment for Ectopic Pregnancy. Clinical Obstetrics & Gynecology. 2012;55(2):433-9. REVISION & APPROVAL HISTOR Methotrexate can cause sickness, vomiting, diarrhoea, loss of hair and skin rashes. These side effects often occur at the beginning of treatment but settle as you become used to the medication. . Methotrexate can affect the production of some of the cells in the bone marrow. This can make you more prone to infections, or cause problems with.

A Family Physicians' Guide to Monitoring Methotrexate

  1. Methotrexate. Methotrexate is one of the most commonly used corticosteroid-sparing therapies for sarcoidosis, due to its effectiveness, low cost and, at the dosages used to treat sarcoidosis, relatively low risk of side effects compared to other cytotoxic agents. The drug can be given orally or subcutaneously
  2. The guidelines varied substantially in the ways they were constructed. Three guidelines [15, 22, 28] used Agree II methods and one guideline [16] the Agree method, two used Grade methods [14, 30], one guideline [29] used NICE methods and one guideline [21] the Adapte method. Although other guidelines did not us
  3. ] conventional immunomodulators in the form of thiopurines and methotrexate (MTX), along with glucocorticoids, constitute the basic therapeutic armamentarium. European and American guidelines recommend MTX for active Crohn's disease (CD) as adjunctive therapy or as a steroid-sparing agent to maintain remissio
NICE approval for new psoriasis tablet | MIMS online

BJD GUIDELINES British Association of Dermatologists

  1. imally invasive surgery or with medical management using methotrexate
  2. The National Institute for Clinical Excellence (NICE or the Institute) is part of the UK NHS. It provides guidance for the NHS and patients and their carers that aims to inform decisions about treatment and healthcare. Anne-Toni Rodgers, one of the directors of NICE and an executive lead for many NICE projects, provided an outline of the organisation and the Appraisal Process
  3. The relevant NICE guidelines links are listed below (additional information in Appendix 1). people who cannot take methotrexate because it is contraindicated or because of intolerance, when the above criteria are met. NICE (Aug 2010): Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of.
  4. (NICE guideline NG52) accessed via www.nice.org.uk UCLH - Dosage Adjustment for Cytotoxics in Hepatic Impairment (Version 3 - updated January 2009). UCLH - Dosage Adjustment for Cytotoxics in Renal Impairment (Version 3 - updated January2009). Summary of Product Characteristics Methotrexate (Hospira) accessed 23 Oct 2018 vi
  5. Once Weekly Oral Methotrexate Indications: Active rheumatoid arthritis in adults, severe forms of psoriasis vulgaris, severe psoriatic arthritis1 Usual dose range for rheumatology indications: 7.5-25mg orally ONCE WEEKLY (see SmPC for individual dosing per indication) Monitoring: Ensure appropriate monitoring of bloods whether in primary or secondary care (rheumatology clinics)

methotrexate and for 3 months after stopping methotrexate. Limited evidence suggests low-dose methotrexate may be compatible with paternal exposure. If pregnancy occurs whilst on low dose methotrexate or within 3 months of stopping, folate supplementation (5 mg/day) should be continued throughout pregnancy The UK's National Institute for Health and Care Excellence (NICE) has released final draft guidance recommending that the National Health Services offer several treatments for patients with moderate-to-severe rheumatoid arthritis. NICE recommended the biologics adalimumab, etanercept and infliximab, when taken with methotrexate, but added that adalimumab and etanercept can be taken as. Alarcon, G. S. & Morgan, S. L. Guidelines for folate supplementation in rheumatoid arthritis patients treated with methotrexate: comment on the guidelines for monitoring drug therapy. Arthritis.

Trust Guideline for the Management of:

Ectopic pregnancy and miscarriage (NICE clinical guideline 154) This clinical guideline offers evidence-based advice on the diagnosis and management of ectopic pregnancy and miscarriage in early pregnancy (that is, up to 13 completed weeks of pregnancy). This guideline was produced by the National Collaborating Centre for Women's and Children. For people with newly diagnosed rheumatoid arthritis, the NICE guideline on rheumatoid arthritis recommends a combination of conventional DMARDs (including methotrexate and at least 1 other. The guideline reported that there were four groups, three case series and a case report that looked at 263 pregnancies where fathers were taking low dose methotrexate. The journal stated that: 'Overall, the quality of these studies was low with information lacking from several studies primarily looking at safety of other medications

British Association of Dermatologists - Clinical Guideline

  1. Methotrexate is not recommended in pregnancy or while trying for a baby. This medicine can stay in a woman's body for 6 months after they stop taking it. For men, there is a risk that methotrexate can damage sperm. This can affect the way a baby develops during pregnancy
  2. NICE guideline NICE rheumatoid arthritis guideline. 2020-10-16T14:57:00Z. This updated summary of the NICE rheumatoid arthritis guideline includes recommendations on referral, diagnosis, and investigation
  3. These guidelines differ from others because it recommends TNFi biologics first for most people. Most other recommendations suggest methotrexate as the first drug for treatment. The ACR/NPF guidelines also suggest treat to target. This means your doctor will set a goal and monitor your response to the drugs often, adjusting as needed.
  4. Sunderland shared care guideline: Methotrexate for Neurology 1.1- Jan 2018. Review June 2021 Page 3 of 8 If the patient develops oral ulceration, abnormal bruising, sore throat or an unexplained rash then reduce dose or withhold methotrexate if severe until FBC available and discuss with neurology tea
  5. Many women will experience complications in early pregnancy. The loss of a pregnancy can cause considerable emotional distress for women and their families, as well as physical morbidity that results in over 50 000 inpatient admissions in the UK annually.1 The mortality associated with ectopic pregnancy is decreasing but remains at an estimated 0.2 per 1000 ectopic pregnancies. Of the women.

Methotrexate is a folic acid antagonist which belongs to the class of cytotoxic agents known as antimetabolites. It acts by the competitive inhibition of the enzyme dihydrofolate reductase and thus inhibits DNA synthesis. It has not yet been clarified, as to whether the efficacy of methotrexate, in the management of psoriasis, psoriasis. This guideline supersedes the previous BSR/BHPR anti-TNF , rituximab (RTX) and tocilizumab (TCZ) guidelines and has been developed in line with the BSR Guidelines Protocol. It covers safety recommendations for all biologic therapies approved by the National Institute for Health and Care Excellence (NICE) up to June 2016, for use in all. Most of the national and international guidelines on the management of rheumatoid arthritis (eg, National Institute for Health and Care Excellence [NICE], Scottish Intercollegiate Guidelines Network, European League Against Rheumatism and the ACR) advise on methotrexate's place in therapy but do not discuss folic acid supplementation.1 2 29. ### What you need to know Miscarriage and ectopic pregnancy have an adverse effect on the quality of life of many women, with early pregnancy loss accounting for over 50 000 hospital admissions in the UK annually.1 Ectopic pregnancy (where the pregnancy implants outside the endometrial cavity, most commonly within the fallopian tube) occurs in approximately 11 per 1000 pregnancies.2.

Non-TNF-targeted therapies more effective than anti-TNFGGC Medicines

Last Updated: November 3, 2020. Patients with severe COVID-19 can develop a systemic inflammatory response that can lead to lung injury and multisystem organ dysfunction. It has been proposed that the potent anti-inflammatory effects of corticosteroids might prevent or mitigate these deleterious effects. The Randomised Evaluation of COVID-19. Ulcerative colitis and Crohn's disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership. Rheumatoid arthritis in adults: management (2018) NICE guideline NG100, recommendation 1.1.1. The 3-working-days timeframe is based on expert opinion and not derived from NICE's guideline on rheumatoid arthritis in adults. It is considered a practical timeframe to enable stakeholders to measure performance Methotrexate is a folic acid antagonist and is classified as an antimetabolite cytotoxic agent. Methotrexate has been used to produce regression in a wide range of neoplastic conditions including acute leukaemias, non-Hodgkin's lymphoma, soft-tissue and osteogenic sarcomas, and solid tumours particularly breast, lung, head and neck, bladder, cervical, ovarian, and testicular carcinoma