LAUSR

Several studies have shown subcutaneous methotrexate (s/c MTX) to be superior to oral for treatment of rheumatoid arthritis. However s/c MTX is rarely started first line. We audited the first 67 patients started on s/c MTX at diagnosis and compared to a previous cohort of treat-to-target patients started on oral MTX. There was a significant difference in adherence: for every 1 patient staying on oral, 1.5 patients stayed on s/c MTX. There was no difference in final numbers in remission, escalation to biologics, or time to remission. Nearly half the patients on oral MTX had switched to s/c at 1 year, either for side effects or inefficacy. Adherence to s/c MTX was better than adherence to oral MTX in our study. The large number of switches from oral to s/c suggests that adherence is improved due to improved tolerability and reduced side effects of s/c MTX. C. Bevington None. K. Achilleos None. J. Smith Grants/research support; JS received £500 from Medac to carry out the audit. V. Smith: None.