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Tumour necrosis factor inhibitor (TNFi) treatment in patients with rheumatoid arthritis is more effective when combined with methotrexate (MTX).1–3 However, little is known about which MTX dose to use. With great interest, we read the article by Burmester et al4 on the efficacy and safety of ascending MTX doses with adalimumab. This randomised double-blind study showed comparable results for adalimumab with 10 and 20 mg MTX, in MTX naive patients. Because of the potential side effects, it is often preferred to use MTX doses as low as possible. Therefore, the following questions arise: what happens in daily practice with MTX plus adalimumab, where most patients are not MTX naive when starting TNFi, and are the results the same for etanercept and infliximab?
Data were collected within the Dutch RhEumatoid Arthritis …
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