{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:31:57Z","timestamp":1790209917252,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2020,7,29]],"date-time":"2020-07-29T00:00:00Z","timestamp":1595980800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["P30\u2010AR072577"],"award-info":[{"award-number":["P30\u2010AR072577"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp;amp; Research"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Methotrexate (<jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content>) increases the risk of alopecia and stomatitis, but the prevalence of these adverse events among rheumatic patients taking <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content> is poorly defined. We conducted a systematic literature review and meta\u2010analysis to estimate the prevalence of alopecia and stomatitis with <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content> in rheumatic diseases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched PubMed, The Cochrane Library, and <jats:styled-content style=\"fixed-case\">CINAHL<\/jats:styled-content> databases for double\u2010blind randomized controlled trials (<jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s) with an <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content> monotherapy arm. Alopecia, stomatitis, and oral\/mouth ulcers data were extracted. The quality of trials was assessed by 2 authors. We included trials published since 1990 that used at least 10 mg of <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content> weekly, coadministered with folic or folinic acid. We estimated the prevalence using random\u2010effects models because heterogeneity was anticipated. Two estimates of prevalence were included; the lower bound estimate included all trials (assuming no alopecia and stomatitis if not mentioned), and the upper bound estimate included only those that specifically described prevalence estimates of alopecia or stomatitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 3,954 studies identified, 20 <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s were included, with a total of 24 <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content> monotherapy arms, of which 10 reported the prevalence of alopecia (n = 1,113), and 21 reported stomatitis or mouth\/oral ulcers (n = 2,056). The prevalence of alopecia was between 1.0% and 4.9%. The prevalence of stomatitis was between 5.7% and 8.0%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This meta\u2010analysis gives more precise estimates of mucocutaneous adverse events that occur in rheumatic disease patients taking <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content>. These estimates will help inform patient decision\u2010making regarding <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.23999","type":"journal-article","created":{"date-parts":[[2019,5,31]],"date-time":"2019-05-31T11:39:26Z","timestamp":1559302766000},"page":"1140-1146","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Low\u2010Dose Methotrexate and Mucocutaneous Adverse Events: Results of a Systematic Literature Review and Meta\u2010Analysis of Randomized Controlled Trials"],"prefix":"10.1002","volume":"72","author":[{"given":"Riyana","family":"Lalani","sequence":"first","affiliation":[{"name":"Brigham and Women\u2019s Hospital, Boston, Massachusetts, and Florida Atlanta University Charles E. Schmidt College of Medicine  Boca Raton"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houchen","family":"Lyu","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital, Boston, Massachusetts, and General Hospital of the Chinese People\u2019s Liberation Army  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Vanni","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8202-5428","authenticated-orcid":false,"given":"Daniel H.","family":"Solomon","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,7,29]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-107-2-358"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780290702"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780350202"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keh088"},{"key":"e_1_2_6_6_1","unstructured":"HigginsJP GreenS.Cochrane handbook for systematic reviews of interventions.2011. 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