The objective of this review is to update the recommendations of the 2010 
Italian Consensus on the use of methotrexate (MTX) in rheumatoid arthritis (RA) 
and other rheumatic diseases. The literature published between 2008 and 2012 was 
systematically reviewed and updated recommendations on MTX use in rheumatic 
diseases, particularly RA, were formulated. These recommendations were approved 
by a panel of expert Italian Rheumatologists. A total of 10,238 references were 
identified, among which 70 studies were selected for critical evaluation. 
Sufficient evidence had accumulated to warrant changes to several of the 
recommendations in the new version. A new recommendation for patients with RA 
who are in MTX-induced clinical remission was also proposed and approved by the 
panel. Updated recommendations for the use of MTX in patients with RA or other 
rheumatologic disease are proposed.