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Frequency of methotrexate intolerance in rheumatoid arthritis patients using methotrexate intolerance severity score

Nibah Fatimah1,2, Babur Salim3, Amjad Nasim3

  • 1Fauji Foundation Hospital, Jhelum road, Rawalpindi, 46000, Pakistan. nibahfatimah@gmail.com.

Clinical Rheumatology
|April 8, 2016
PubMed

Insights

Methotrexate intolerance affects 33.3% of rheumatoid arthritis patients, with behavioral symptoms being most common. Higher methotrexate doses increase intolerance risk, impacting treatment adherence.

Area of Science:

  • Rheumatology
  • Clinical Pharmacology

Background:

  • Rheumatoid arthritis (RA) management often involves methotrexate (MTX), a cornerstone disease-modifying antirheumatic drug (DMARD).
  • Methotrexate intolerance (MTX-I) can significantly impact patient adherence and treatment outcomes.
  • Understanding the prevalence and contributing factors of MTX-I is crucial for optimizing RA therapy.

Purpose of the Study:

  • To determine the frequency of MTX intolerance in RA patients using the Methotrexate Intolerance Severity Score (MISS) questionnaire.
  • To investigate the influence of MTX dosage and concurrent use of other DMARDs on MTX intolerance.

Main Methods:

  • A descriptive study was conducted with 150 female RA patients using oral MTX.
  • The MISS questionnaire assessed five symptoms: abdominal pain, nausea, vomiting, fatigue, and behavioral changes, with a severity scale.
  • Physicians diagnosed MTX intolerance with a MISS score of 6 or higher.

Main Results:

  • A prevalence of 33.3% for MTX intolerance was observed in the study population.
  • Behavioral symptoms (44%) were the most frequent complaint, while vomiting (11%) was the least common.
  • Higher weekly MTX doses (20 mg) correlated with increased intolerance (46.2%), whereas lower doses (7.5 mg) showed reduced intolerance (20%).
  • Concomitant use of other DMARDs did not significantly increase MTX intolerance.

Conclusions:

  • Methotrexate intolerance is moderately prevalent in RA patients and is directly related to the MTX dose.
  • Undetected MTX intolerance can lead to decreased patient compliance with first-line MTX therapy.
  • The study suggests that MTX dosage adjustment, rather than avoidance of other DMARDs, may be key in managing MTX intolerance.
Keywords:
Concomitant DMARD therapyMethotrexateMethotrexate doseMethotrexate intolerance severity scoreRheumatoid arthritis

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