Methotrexate is an antineoplastic that acts as an antimetabolite of folic acid. It also has immunosuppressant properties and is most commonly used ingeneral practice as a disease modifying anti-rheumatic drug for the treatment of moderate to severe rheumatoid arthritis and psoriasis. Methotrexate is of value in the treatment of psoriasis but because of the risks associated with this use, it should only be given when the disease is severe and has not responded to other forms of treatment. Management of rheumatoid arthritis is conventionally begun with an analgesic and an NSAID for symptomatic relief, to which a disease-modifying antirheumatic drug (DMARD) is subsequently added in an attempt to retard the disease process.
It is now clear that irreversible joint damage commonly occurs in early disease and rheumatologists now generally add the DMARD shortly after rheumatoid arthritis has been diagnosed. Methotrexate is widely used, and is the DMARD of first choice in many patients. Systematic review has confirmed that methotrexate has significant benefit in the short-term treatment of the disease. In terms of cost methotrexate is an inexpensive drug however the National Patient Safety Agency (NPSA) issued an alert in July 2004 highlighting the potential hazards of this drug to NHS trusts. They requested that NHS organisations should take steps to ensure that this drug is prescribed and monitored safely and that patients receive the core patient information leaflets and monitoring documents produced by the NPSA. NHS organisations were also charged with self-assessing locally the safe prescribing, safe dispensing and safe administration checklists. This audit looks at safe prescribing and monitoring of oral methotrexate in general practices.