Users' Guides to the Medical Literature

CLINICAL SCENARIO

You are a physician following a 35-year-old man who has had active Crohn disease for 8 years. The symptoms were severe enough to require resectional surgery 4 years ago, and despite treatment with sulfasalazine and metronidazole, the patient has had active disease requiring oral steroids for the last 2 years. Repeated attempts to decrease the prednisone have failed, and the patient has required doses of greater than 15 mg per day to control symptoms. You are impressed by both the methods and results of a recent article¹documenting that such patients benefit from oral methotrexate and suggest to the patient that he consider this medication. When you explain some of the risks of methotrexate, particularly potential liver toxicity, the patient is hesitant. How much better, he asks, am I likely to feel while taking this medication?

INTRODUCTION

There are 3 reasons we offer treatment to our patients.