Nice commentary! Our tendency to think binary can sometimes be problematic- I always urge fellows to embrace the paradoxes. Agree tapering is not for everyone, stopping is definitely not. Like you mentioned tapering could be considered for that interested patient, perhaps seronegative in deep remission w PtGA 0. Keeping an open mind only facilitates shared decisions informed by the evidence. Could slowly tapering MTX to 1/2 dose be an option for the above pt (Arctic rewind study JAMA 2021 but w slow taper not abrupt, and Meta-analysis on MTX de-esc Meng et al 2023) ?
Nice commentary! Our tendency to think binary can sometimes be problematic- I always urge fellows to embrace the paradoxes. Agree tapering is not for everyone, stopping is definitely not. Like you mentioned tapering could be considered for that interested patient, perhaps seronegative in deep remission w PtGA 0. Keeping an open mind only facilitates shared decisions informed by the evidence. Could slowly tapering MTX to 1/2 dose be an option for the above pt (Arctic rewind study JAMA 2021 but w slow taper not abrupt, and Meta-analysis on MTX de-esc Meng et al 2023) ?