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American Journal of Obstetrics and Gynecology, 220 (1), B2B18

Patients require evaluation before starting DMARDs to rule out contraindications to the medications (meaning the patient should not take a certain medication due to the harm it would cause) and monitoring while using them to watch for serious side effects

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While the treatment groups improvements were maintained after six months of supplementation (0.60 at month 12), there was a further 1.9% deterioration in the placebo group (0.53 to 0.52) ( p = 0.012)