Therapy of Rheumatoid Arthritis with Methotrexate in Germany

I've just read an article by J. Zeidler and colleagues, who looked at data provided by one of the large German health insurance companies: "Therapy of rheumatoid arthritis with methotrexate. Claims data analysis of treatment patterns." [Z Rheumatol 2012 71:900-907 / DOI 10.1007/s00393-012-1027-3]

What did the authors find?
70% of the patients received a dosage of methotrexate (MTX) in between 10 and 25 mg. The most common DMARD combination has been MTX and leflunomide. They found that only 65% of patients on MTX were substituted with folic acid, which is contrary to recommendations. Only 8% were treated exclusively with oral MTX. 48% of patients were treated exclusively with parenteral MTX!
In a cohort of 9579 patients they've detected even lesser used combinations such as MTX + penicillamine (4 pats.), MTX + auranofin (13 pats.), MTX + sodiumaurothiomalate (36 pats.).
MTX + TNF-alpha-inhibitors made up 15.6% of all patients.
There are also patients receiving combinations that hardly tested at all: MTX + leflunomide + hydroxychloroquine (93 pats.) or MTX + leflunomide + sulfasalazine (82 pats.).
81% of patients received MTX + glucocorticoids at some time of their therapy, whereof prednisolone made up for 70.8%.

I'm quite surprised about the high precentage of patients, who aren't substituted with folic acid. In our center we routinely prescribe 5 mg folic acid two days after MTX.