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Relapse of rheumatoid arthritis after substitution of oral for parenteral administration of methotrexate
  1. A Rozin1,
  2. D Schapira1,
  3. A Balbir-Gurman1,
  4. Y Braun-Moscovici1,
  5. D Markovits1,
  6. D Militianu2,
  7. M A Nahir1
  1. 1B Shine Department of Rheumatology, Rambam Medical Centre and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
  2. 2Department of Medical Imaging, Rambam Medical Centre and Faculty of Medicine
  1. Correspondence to:
    Dr A Rozin, Department of Rheumatology, Rambam, Medical Centre, PO Box 9602, Haifa 31096, Israel;

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We read with interest the letters: “Is parenteral methotrexate worth trying?” by Osman and Mulherin1 and “Intramuscular methotrexate in inflammatory rheumatic disease” by Burbage, Gupta, and Lim.2 We would like to present our findings, which indicate that parenteral methotrexate (MTX) may be more efficient than oral MTX at the same dose and in the same patients with inflammatory joint disease.

During the second half of 2000 we were faced with an unexpected shortage of parenteral MTX (ABIC, Israel) which lasted for more than five months, and patients were switched to oral MTX (Lederle, Germany). This gave us the opportunity to evaluate the difference in efficacy of parenteral versus oral administration of low dose MTX.


Eight patients (seven female) with a mean age of 55 (38–70) years, who fulfilled the following criteria, were analysed retrospectively: (a) all had inflammatory joint diseases (four seropositive rheumatoid arthritis (RA), two seronegative RA (revised American Rheumatism Association criteria for RA), and two RA-like psoriatic arthropathy); (b) all were receiving parenteral MTX and were in complete clinical remission (fulfilling at least five of six …

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