Session Type: Abstract Submissions (ARHP)
Methotrexate has become the core DMARD for the treatment of Rheumatoid Arthritis. It has also found utility in treating other forms of inflammatory arthritis including Psoriatic, and can be used to reduce corticosteroid therapy. We were struck by the number of patients who complain of side effects that interfere with their lives but are not sufficiently serious to need withdrawal. We surveyed our own patients and found that 57% had at least 1 side effect. We were interested to see if this pattern was repeated in other places in the UK and to determine whether patients reported side effects and adherence differently to Doctors and Nurses.
A steering group of participants was organised to reflect a wide geographical spread throughout England Scotland and Ireland and included nurses and consultants. The questionnaire was slightly modified to include questions about adherence. 50 consecutive patients on Methotrexate for any reason, who were on a stable dose and planning to continue, were surveyed from each site, 100 patients were surveyed from Glasgow in Scotland.
The patient report rate of any side effect was higher in all of the new centres compared to our first survey ranging between 67% to 86%. The biggest report rate difference was fatigue where there was an increase of up to 3.5 fold of patients reporting this side effect. Up to twice as many patients were reporting other side effects than were reported in the original survey.
Adherence was explored with questions about choosing not to take and forgetting to take. Choosing not to take ranged from 2% to 8%, with high VAS scores for severity of side effects which suggests that the decision to choose not to take Methotrexate was related to severity of side effects. Patient response to forgetting to take Methotrexate showed more variation, ranging from 0 to 18% and they rated lower VAS scores for severity of side effects. It is interesting to note that the survey completed by the nurse produced the highest disclosure of non-adherence by the patients; this may reflect on the way nurses communicate with patients. Numbers of missed weeks ranged between 2 and 4.
These surveys have shown a very high rate of side effects that patients are prepared to put up with for the benefits they get from Methotrexate. The main variation is in the complaint of Fatigue which is very subjective. The variation in admission of non adherence is interesting and merits further study as it may be an underestimate.
P. S. Heslop,
A. O. Adebajo,
Novartis Pharmaceutical Corporation,
S. M. Robinson,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-multi-centre-survey-of-tolerability-problems-for-patients-on-regular-methotrexate/