Background/Purpose: Methotrexate (MTX) is commonly used in the treatment of children with juvenile idiopathic arthritis (JIA). It frequently has to be discontinued due to intolerance with anticipatory and associative gastrointestinal symptoms. Eye Movement Desensitization and Reprocessing (EMDR) is a therapy where non-processed and dysfunctional experiences and memories are reprocessed by intensive recall combined with eye movements. This leads to selective processing of the negative affect.

The objective of this study was to investigate effectiveness of EMDR in the treatment of MTX intolerance in JIA patients, with the underlying hypothesis that intolerance occurs due to dysfunctional memories and expectations.

Methods: An open prospective study on consecutive JIA patients with MTX intolerance was performed. Intolerance was determined using the Methotrexate Intolerance Severity Score (MISS) questionnaire, and health-related quality of live was determined using the PedsQL, at 3 time points: directly before and after treatment (after treatment: MISS only), as well as 4 months after treatment. Patients were treated using a standardized EMDR protocol with 8 sessions over a time period of 2 weeks. Changes in MISS and PedsQL were compared using descriptive and non-parametric methods.

Results: 14 patients with MTX intolerance (median MISS at inclusion: 13.5, range: 6-26) were included. Directly after treatment, all patients reported marked improvement of MTX intolerance symptoms (median MISS: 0.5, range: 0-3, p=0.001). After 4 months, lasting reduction of MTX intolerance symptoms was observed (n=5, median MISS: 5, range: 0-10, p=0.068). However, 2/5 patients (40%) showed renewed signs of MTX intolerance with MISS >6. The health-related quality of life showed a trend towards improvement 4 months after treatment (n=5, median pedsQL prior to treatment 84.4%, 4 months after treatment 92.4%, p=0.46).

Conclusion: MTX intolerance in children with JIA can effectively be treated using an EMDR protocol, with lasting improvement over a period of 4 months. This intervention could potentially increase quality of life in affected patients and enable continued treatment with MTX as an effective, economic and well-tolerated medication.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/successful-treatment-of-methotrexate-intolerance-in-juvenile-idiopathic-arthritis-using-eye-movement-desensitization-and-reprocessing-emdr/