Prevalence of methotrexate intolerance in rheumatoid arthritis and psoriatic arthritis.

Maja Bulatović Ćalasan,Oscar F C Van Den Bosch,Martijn Custers,Marjonne C W Creemers,Nico M Wulffraat,Jan Maarten Van Woerkom,Antonius H M Heurkens

doi:10.1186/ar4413

Maja Bulatović Ćalasan, Oscar F C Van Den Bosch + Show 5 more

Open Access

https://doi.org/10.1186/ar4413

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Abstract

IntroductionThe aim of this study was to determine the prevalence of gastrointestinal and behavioural symptoms occurring before (anticipatory/associative) and after methotrexate (MTX) administration, termed MTX intolerance, in rheumatoid (RA) and psoriatic arthritis (PsA).MethodsMethotrexate Intolerance Severity Score (MISS), previously validated in juvenile idiopathic arthritis patients, was used to determine MTX intolerance prevalence in 291 RA/PsA patients. The MISS consisted of four domains: abdominal pain, nausea, vomiting and behavioural symptoms, occurring upon, prior to (anticipatory) and when thinking of MTX (associative). MTX intolerance was defined as ≥6 on the MISS with ≥1 point on anticipatory and/or associative and/or behavioural items.ResultsA total of 123 patients (42.3%) experienced at least one gastrointestinal adverse effect. The prevalence of MTX intolerance was 11%. MTX intolerance prevalence was higher in patients on parenteral (20.6%) than on oral MTX (6.2%) (p < 0.001).ConclusionBesides well-known gastrointestinal symptoms after MTX, RA and PsA patients experienced these symptoms also before MTX intake. RA and PsA patients on MTX should be closely monitored with the MISS for early detection of MTX intolerance, in order to intervene timely and avoid discontinuation of an effective treatment.

Highlights

The aim of this study was to determine the prevalence of gastrointestinal and behavioural symptoms occurring before and after methotrexate (MTX) administration, termed MTX intolerance, in rheumatoid (RA) and psoriatic arthritis (PsA)
MTX intolerance severity score To determine the prevalence of MTX-induced gastrointestinal adverse effects, patients completed the methotrexate intolerance severity score (MISS), previously developed and validated in juvenile idiopathic arthritis (JIA) [13]
We showed that besides the well-known MTX-induced gastrointestinal symptoms upon MTX administration, RA and PsA patients had anticipatory and associative gastrointestinal and behavioural symptoms before MTX administration, collectively termed MTX intolerance

Summary

Introduction

The aim of this study was to determine the prevalence of gastrointestinal and behavioural symptoms occurring before (anticipatory/associative) and after methotrexate (MTX) administration, termed MTX intolerance, in rheumatoid (RA) and psoriatic arthritis (PsA). In RA and PsA treatment, methotrexate (MTX) is the first-choice disease-modifying anti-rheumatic drug (DMARD) due to low costs, efficacy and an acceptable safety profile [3,4]. Serious adverse effects such as pulmonary toxicity, hepatotoxicity and bone marrow suppression are rare or transient if MTX is stopped [5]. We showed in juvenile idiopathic arthritis (JIA) that 50.5% of patients suffered from a myriad of gastrointestinal adverse effects after MTX intake, and from adverse effects before MTX intake (anticipatory) and when thinking of MTX (associative) [13]. MTXinduced gastrointestinal adverse effects occur frequently in RA and PsA, severity and the type - in particular the occurrence of anticipatory and associative symptoms have not been assessed

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