Rheumatologists' recommended patient information when prescribing methotrexate for rheumatoid arthritis

Accurate communication of information concerning the risks and benefits of medications is essential for adherence and patient safety. A diverse array of information and sources makes it difficult to know exactly what to tell a patient with rheumatoid arthritis about methotrexate.

Our objective is to determine what key information patients must know about methotrexate and the key reasons they should call their doctor while they are taking methotrexate.

Three hundred and forty-four Canadian rheumatologists were sent a survey containing open-ended questions to gain uncued narrative perspectives from each individual's experience. The survey was designed to determine what must all patients taking methotrexate know and when must patients taking methotrexate call a physician? Emergent coding was used to establish a set of categories to form a checklist for coding. A second member checking survey was sent to gain confirmation and validation of themes developed from the initial survey.

One hundred and seventy out of 344 (49.5%) surveys were completed. Regular blood testing, once weekly dosing, risk of infection, pregnancy and lactation information, alcohol limitation, potential lung toxicity, and drug interactions were thought to be important. Patients should call if they became pregnant, developed symptoms suggestive of lung toxicity, developed an infection, severe mouth sores, or were concerned about any side effects warranting the discontinuation of the medication.

This study is the first to describe, from a rheumatologist's perspective, the key important information that all patients should know and when patients should call their doctor when taking methotrexate.