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Methotrexate in Rheumatoid Arthritis: Feedback on American College of Physicians Guidelines

Peter Tugwell, MD; Kathryn Bennett, MSc; Mary Bell, MD; and Michael Gent, MD
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Requests for Reprints: Peter Tugwell, MD, Chedoke Hospital, Sanitorium Road, T. B. #74, Room 20, Hamilton, Ontario L8N3Z5, Canada.

McMaster University, Hamilton, Ontario

Ann Intern Med. 1989;110(8):581-583. doi:10.7326/0003-4819-110-8-581
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The American College of Physicians (ACP) guidelines and the background paper on the use of methotrexate in rheumatoid arthritis published in this journal last year (1, 2) have stimulated useful discussions around a number of issues. Most of these issues were discussed by the ACP Clinical Efficacy Assessment Project subcommittee before the guidelines were published, but this editorial discusses some different perspectives.

The feedback from the rheumatology community, with some exceptions arising from a concern about medico-legal implications, has been positive about the courage of the College in publishing guidelines for a drug before its approval for this use by


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