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Rheumatology Advance Access originally published online on August 18, 2008
Rheumatology 2008 47(10):1591; doi:10.1093/rheumatology/ken327
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Comment on: BSR/BHPR guideline for disease-modifying anti-rheumatic drug (DMARD) therapy in consultation with the British Association of Dermatologists: reply

K. Chakravarty1

1Rheumatology Department, Queen's; Hospital, Essex, UK

Correspondence to: K. Chakravarty, Rheumatology Department, Queen's Hospital, Rom Valley Way, Romford, Essex RM7 OBE, UK. E-mail: kuntal{at}talk21.com

Sir, We would like to thank Dr Bhalla and his colleague [1] for raising an important but rather rare and unusual occurrence of a skin reaction in patients treated with MTX with previous history of radiotherapy, following the publication of DMARD Guideline [2]. The literature review reveals only one case report where MTX was involved but similar dermatological reaction was also reported with many other drugs including antibiotics, Hyocin, cytotoxics and even St John's wort. The exact mechanism of such a reaction is unknown but it is reassuring to note that the skin reaction improves soon after the discontinuation of the drugs. It would be interesting to explore if the patients reported by authors were on any other concomitant drug therapy that may have played a causal role.

We appreciate the advice for inclusion of an oncologist in future but the issue relates to clinical dermatology and we were privileged to have a valued representation from British Association of Dermatologists.

Disclosure statement: The author has declared no conflicts of interest.


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  1. Bhalla AK, Samaranayaka M. Comment on: BSR/BHPR guideline for disease-modifying anti-rheumatic drug (DMARD) therapy in consultation with the British Association of Dermatologists. Rheumatology (2008) 47:1591.[Free Full Text]
  2. Chakravarty K, McDonald H, Pullar T, et al. BSR/BHPR guideline for disease-modifying anti-rheumatic drug (DMARD) therapy in consultation with the British Association of Dermatologists. Rheumatology (2008) 47:924–5.[Free Full Text]
Accepted 9 July 2008


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This Article
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