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Coping strategies and anxiety in association with methotrexate-induced nausea in juvenile idiopathic arthritis

Nini Kyvsgaard1, Mikael Thastum2, Torben Stamm Mikkelsen3

  • 1Pediatric and Adolescent Medicine, Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. nini.kyvsgaard@rm.dk.

Rheumatology International
|January 31, 2020
PubMed

Insights

Methotrexate-induced nausea in children with juvenile idiopathic arthritis is linked to anxiety and specific coping strategies. Understanding these connections can help manage treatment side effects.

Area of Science:

  • Pediatric Rheumatology
  • Clinical Psychology
  • Pharmacology

Background:

  • Juvenile idiopathic arthritis (JIA) is a chronic condition requiring treatment with methotrexate (MTX).
  • MTX can cause nausea, impacting treatment adherence and quality of life.
  • The role of psychological factors like anxiety and coping strategies in MTX-induced nausea is not fully understood in JIA patients.

Purpose of the Study:

  • To investigate the association between methotrexate-induced nausea and anxiety in children with JIA.
  • To explore the relationship between MTX-induced nausea and the use of coping strategies in this pediatric population.
  • To identify potential psychological mechanisms contributing to variable nausea experiences during MTX therapy.

Main Methods:

  • Observational study of 121 children (aged ≥9 years) diagnosed with JIA and treated with MTX.
  • Nausea assessed using a nausea diary and the Methotrexate Intolerance Severity Score (MISS).
  • Anxiety measured with the Beck Youth Inventories-Anxiety Inventory (BYI-A); coping strategies evaluated with an adapted Nausea Coping Questionnaire.

Main Results:

  • MTX-induced nausea was reported by 61% (MISS) to 73% (diary) of children.
  • Nausea was significantly associated with higher anxiety scores (BYI-A) and increased use of internalizing/catastrophizing coping strategies.
  • These associations were consistent across both nausea assessment methods.

Conclusions:

  • Anxiety and specific maladaptive coping strategies are linked to methotrexate-induced nausea in children with JIA.
  • Psychological factors may play a crucial role in the inter-individual variability of MTX-related nausea.
  • Findings suggest potential targets for interventions to mitigate nausea and improve treatment outcomes in pediatric JIA patients.

Keywords:
AnxietyCoping strategiesJuvenile idiopathic arthritisMethotrexateNausea

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