Related Experiment Video
Updated: Jul 31, 2025
Preliminary Study on Acupuncture Combined with Grain-sized Moxibustion for Treating Rheumatoid Arthritis with Finger Joint Pain
Published on: May 16, 2025
Barriers and Enablers in the Use of Parenteral Methotrexate in Rheumatoid Arthritis Patients: A Scoping Review
Jiun Ming Tan1, Emily Reeve2, Lauren Fraser1
1University of South Australia, Adelaide, South Australia, Australia.
Objective:
Methotrexate (MTX) is effective in controlling disease activity in rheumatoid arthritis (RA). Parenteral MTX may have benefits over oral MTX, but it is rarely used in practice. To better understand this low usage rate, it is necessary to explore the barriers and enablers of therapy from the perspective of RA patients. The objectives of this scoping review were to describe RA patients' perspectives on the barriers and enablers in the use of parenteral MTX and to identify the research gaps in this field.
Methods:
The search was performed in Medline, Embase, Scopus, and Cochrane Library from inception to May 2021. Data synthesis was conducted using the Theoretical Framework of Acceptability. This scoping review included any type of study that explored the use of parenteral MTX by adult RA patients from the patients' perspective, written in English.
Results:
Fifteen studies were included; findings related to the constructs "affective attitude," "burden," "intervention coherence," and "self-efficacy" were explored the most, while some were rarely ("opportunity cost" and "perceived effectiveness") or not ("ethicality") reported. RA patients were generally satisfied with MTX injections ("affective attitude"). From the burden construct, the requirement for dexterity for administering MTX by injection was considered a barrier, whereas the lack of significant pain from MTX injection was considered an enabler.
Conclusion:
The findings suggested that patients generally preferred parenteral MTX formulations with attributes that facilitate self-administration. However, much of the identified research focused on prefilled pen devices, and significant gaps were identified, such as a lack of qualitative research.
Insights
Rheumatoid arthritis patients generally prefer injectable methotrexate (MTX) when it is easy to self-administer. Dexterity for injections can be a barrier, but less pain is an enabler.
Area of Science:
- Rheumatology
- Patient-Reported Outcomes
- Pharmaceutical Sciences
Background:
- Methotrexate (MTX) is a cornerstone therapy for rheumatoid arthritis (RA).
- Parenteral MTX may offer advantages over oral administration but sees limited use.
- Understanding patient perspectives on parenteral MTX barriers and enablers is crucial for improving its uptake.
Purpose of the Study:
- To conduct a scoping review of RA patients' perspectives on barriers and enablers of parenteral MTX use.
- To identify existing research gaps concerning patient views on injectable MTX.
Main Methods:
- A comprehensive literature search was conducted across major databases (Medline, Embase, Scopus, Cochrane Library) up to May 2021.
- Data synthesis employed the Theoretical Framework of Acceptability.
- Included studies focused on adult RA patients' perspectives on parenteral MTX, irrespective of study design.
Main Results:
- Fifteen studies were included, with "affective attitude," "burden," "intervention coherence," and "self-efficacy" being the most explored constructs.
- Patients reported satisfaction with MTX injections, with dexterity for administration identified as a barrier and reduced pain as an enabler.
- Limited research explored "opportunity cost," "perceived effectiveness," and "ethicality."
Conclusions:
- RA patients favor parenteral MTX formulations that support self-administration.
- Current research predominantly focuses on prefilled pen devices.
- Significant research gaps exist, particularly in qualitative studies exploring patient experiences with parenteral MTX.
Related Concept Videos
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
01:29Drug Delivery: Parenteral Route
There are three primary parenteral routes: intravenous (IV), intramuscular (IM), and subcutaneous (SC). The IV route introduces the drug directly into the bloodstream, ensuring immediate action. The IM route...
01:25Routes of Drug Administration: Parenteral
The intravenous route (IV) of drug administration can be further categorized into two types. The bolus injection administers the entire dose rapidly, while an intravenous infusion slowly delivers smaller doses steadily.
The IV route is often...
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Pharmacologic...
01:24Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
01:24Parenteral Anesthetics: Overview