TY - JOUR T1 - Methotrexate in Our Hearts JF - The Journal of Rheumatology JO - J Rheumatol SP - 447 LP - 449 DO - 10.3899/jrheum.181269 VL - 46 IS - 5 AU - LOTTA LJUNG AU - MARIE HOLMQVIST Y1 - 2019/05/01 UR - http://www.jrheum.org/content/46/5/447.abstract N2 - Undoubtedly, methotrexate (MTX) has a unique place in all rheumatologists’ hearts. It holds the position of first-line treatment choice for rheumatoid arthritis (RA) in the European and North American treatment guidelines for RA1,2,3. The benefit of early start of disease-modifying antirheumatic drugs (DMARD), where MTX is the most preferred, has been increasingly emphasized in the last decade. In 2010 an expert task force published recommendations aiming at maximizing patients’ longterm health-related quality of life, through minimizing disease activity in RA as quickly as possible, with the goals of controlling symptoms, normalizing function, and halting radiographic progression of joint damage4. The treatment strategy is widely known as treat to target, and even though it has been questioned5,6, it is now a cornerstone in the modern approach to RA disease activity and treatment.In spite of the strong evidence that the drug is a good first choice for our patients, we still might not use it enough, especially when encountering the onset of RA in the elderly. Patients who develop RA at an older age have higher disease activity and disability, but experience a lesser chance of getting intensive treatment with MTX and other DMARD than their younger counterparts7,8.During the last 20 years we have also become aware that patients with RA have an increased risk of cardiovascular … Address correspondence to Dr. M. Holmqvist, Karolinska Institutet, Department of Medicine, Solna, Clinical Epidemiology Division, Eugeniahemmet T2, SE-171 76 Stockholm, Sweden. E-mail: marie.holmqvist{at}ki.se ER -