ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 565

Factors Associated with Gastrointestinal Tolerance in Patients with Rheumatoid Arthritis and Methotrexate Daily Doses

Adriana Nallely Rangel-Botello1, Marco Ulises Martinez-Martinez2, Carlos Abud Mendoza1, Alexa Bazua Gerez3, Ángel Cárdenas Hernández3, Luis Domínguez Salgado3, José Espinoza Martínez3, Héctor García González3, Oswaldo González Rivera3, Gustavo Hernández de la Cruz3, Germán Magaña Ávila3, Miguel Martínez Rojas3 and Mariana Moctezuma Dávila3, 1Unidad de Investigaciones Reumatológicas y Osteoporosis, Faculty of Medicine, Universidad Autónoma de San Luis Potosí and Hospital Central, San Luis Potosí, Mexico, 2Unidad de Investigaciones Reumatológicas, Faculty of Medicine, Universidad Autónoma de San Luis Potosí and Hospital Central, San Luis Potosí, Mexico, 3Faculty of Medicine, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords:

Session Information

Date: Sunday, November 13, 2016

Title: Rheumatoid Arthritis – Clinical Aspects - ARHP Poster

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Methotrexate (MTX) is the cornerstone of rheumatoid arthritis (RA) treatment. We reported the liver safety with daily dose of MTX1. Weekly doses of MTX are frequently associated with gastrointestinal (GI) adverse events (45-60%)2. The aim of this study is to determine the frequency of methotrexate GI intolerance and its associated factors in patients with RA that receive daily doses of MTX.

Methods: We applied the Spanish version of methotrexate intolerance severity score questionnaire (MISS) in patients with RA, which consists of four domains: abdominal pain, nausea, vomiting and behavioral symptoms. Each domain was ranked from 0-3 points being no complaint (0 points), mild (1 point), moderate (2 points), and severe (3 points)3. The MTX intolerance was determined with a score > 6, and was compared with other variables with Fisher or chi-squared tests; continuous variables were compared with parametric or non-parametric analysis as appropriated. A logistic regression model of MTX intolerance was performed with the relevant variables.

Results: We included 395 unselected patients with RA, 362 (91.6%) were women, mean age was 51.1 ± 12.4 SD years, mean of RA disease evolution 6.4 ± 7.5 SD years and the mean dose of MTX 13.3 ± 4.0 mg/week. The 47.9% (142) of patients had at least one GI adverse event and MTX intolerance was present in 9.4%. Tolerant subjects (52.5%) had at least one gastric symptom: abdominal pain 17.1%, nausea 13.4%, vomiting 1.3%, behavioral symptoms 20.7%. The bivariate analysis for association with MTX intolerance and other drugs showed no statistical significance.

Conclusion: The frequency of GI intolerance using MTX daily doses (9.4%) was similar to MTX weekly as previously reported (11%). Concomitant administration of other drugs was not associated with increasing gastrointestinal intolerance.

  1. Braun J, et al. Arthritis Rheum. 2008 Jan;58(1):73–81
  2. Martinez-Martinez MU, et al. Ann Rheum Dis 2012;71(Suppl3):199.
  3. Bulatovic M, et al. Arthritis Rheum. 2011 Jul;63(7):2007–13 
Table 1. Bivariate analysis
Total Tolerant Intolerant P value
Methotrexate Mean (mg/week dose ±SD ) Cumulative dose (gr ± SD) 13.3 ± 4.0 3.0 ± 3.2 13.6 ± 3.6 3.1 ± 3.3 12.9 ±4.7 2.6 ± 3.5 0.64 0.36
Sulfasalazine (%) 222 (56.2) 174 (58.2) 16 (51.6) 0.48
Chloroquine (%) 144 (36.5) 111 (37.1) 8 (25.8) 0.21
Prednisone (%) Mean dose (mg/day ± SD ) 333(84.3) 4.3 ± 2.7 252 (84.3) 4.2 ± 2.7 28 (90.3) 4.3 ± 2.7 0.37 0.32
NSAID Diclofenac (%) Naproxen (%) Meloxicam (%) 75 (19) 183 (46.3) 82 (20.8) 53 (17.7) 145 (48.5) 69 (23.1) 8 (25.8) 14 ( 45.2) 6 (19.4) 0.26 0.72 0.63

Disclosure: A. N. Rangel-Botello, None; M. U. Martinez-Martinez, None; C. Abud Mendoza, None; A. Bazua Gerez, None; Á. Cárdenas Hernández, None; L. Domínguez Salgado, None; J. Espinoza Martínez, None; H. García González, None; O. González Rivera, None; G. Hernández de la Cruz, None; G. Magaña Ávila, None; M. Martínez Rojas, None; M. Moctezuma Dávila, None.

To cite this abstract in AMA style:

Rangel-Botello AN, Martinez-Martinez MU, Abud Mendoza C, Bazua Gerez A, Cárdenas Hernández Á, Domínguez Salgado L, Espinoza Martínez J, García González H, González Rivera O, Hernández de la Cruz G, Magaña Ávila G, Martínez Rojas M, Moctezuma Dávila M. Factors Associated with Gastrointestinal Tolerance in Patients with Rheumatoid Arthritis and Methotrexate Daily Doses [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/factors-associated-with-gastrointestinal-tolerance-in-patients-with-rheumatoid-arthritis-and-methotrexate-daily-doses/. Accessed .

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