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MTX intolerance in children and adolescents with juvenile idiopathic arthritis
Boris Hügle1, E H Pieter van Dijkhuizen2
1German Center for Paediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany.
Abstract:
MTX is the medication most commonly used for antirheumatic treatment in juvenile idiopathic arthritis. It has high efficacy, is usually well tolerated and has an excellent safety profile. However, frequently intolerance symptoms develop that manifest as nausea, feelings of disgust or abdominal complaints prior to or directly after administration of the medication. No obvious toxicity is causing these intolerance symptoms, but symptoms are strictly limited to MTX and not transferred to other medications. MTX intolerance causes a significant reduction of quality of life in affected patients, frequently puts the treating physician in difficult situations regarding treatment choice, and may lead to uncomfortable decisions whether or not to stop an otherwise effective drug. Conventional countermeasures such as antiemetics, change of route from subcutaneous to oral or vice versa, or taste masking usually have only a limited effect. In this review, we present the current knowledge on MTX intolerance, its clinical picture and commonly employed strategies. We also consider newer behavioural treatment strategies that may offer a more effective symptom control.
Insights
Methotrexate (MTX) effectively treats juvenile idiopathic arthritis but often causes intolerance symptoms like nausea. This review explores MTX intolerance and discusses new behavioral strategies for symptom management.
Area of Science:
- Rheumatology
- Pharmacology
- Gastroenterology
Background:
- Methotrexate (MTX) is a primary antirheumatic drug for juvenile idiopathic arthritis (JIA).
- While effective and safe, MTX frequently causes intolerance symptoms, impacting patient quality of life.
- These symptoms, including nausea and abdominal complaints, are specific to MTX and not due to general toxicity.
Purpose of the Study:
- To review current knowledge on MTX intolerance in JIA.
- To describe the clinical presentation of MTX intolerance.
- To evaluate conventional and novel treatment strategies for MTX intolerance.
Main Methods:
- Literature review of studies on MTX intolerance in JIA.
- Analysis of clinical manifestations and patient-reported outcomes.
- Assessment of treatment efficacy for various countermeasures.
Main Results:
- MTX intolerance significantly reduces quality of life in JIA patients.
- Conventional treatments like antiemetics and route changes offer limited relief.
- Newer behavioral strategies show promise for improved symptom control.
Conclusions:
- MTX intolerance is a significant challenge in JIA management.
- Effective symptom control requires exploring beyond traditional methods.
- Behavioral interventions may offer a more effective approach to managing MTX intolerance in JIA.
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