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Abstract Number: 2393

Is Methotrexate-Induced Nausea in Juvenile Idiopathic Arthritis Influenced By Anxiety or Coping Strategies?

Nini Kyvsgaard1, Mikael Thastum2, Torben Mikkelsen1, Anne Estmann3 and Troels Herlin1, 1Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus N, Denmark, 2Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus C, Denmark, 3Department of Pediatric Rheumatology, H.C. Andersen's Children's Hospital, Odense, Denmark

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Anxiety, coping, juvenile idiopathic arthritis (JIA) and methotrexate (MTX)

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Session Information

Date: Tuesday, October 23, 2018

Title: Pediatric Rheumatology – Clinical Poster III: Juvenile Idiopathic Arthritis and Uveitis

Session Type: ACR Poster Session C

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

Background/Purpose: Nausea to low-dose methotrexate (MTX) is a significant clinical challenge in the treatment of juvenile idiopathic arthritis (JIA). There exists a large inter-individual variation in the level of MTX-induced nausea. Anxiety and coping strategies have been associated to nausea and vomiting induced by high-dose chemotherapy, but has not been investigated in low-dose MTX treatment of JIA. The objective is to investigate if MTX-induced nausea is associated with anxiety or coping strategies in children with JIA treated with low-dose MTX.

Methods: Children were eligible if diagnosed with JIA (ILAR criteria), aged ³9 years, and treated with low-dose MTX. If children were cognitively impaired or not fluent in Danish they were excluded. Enrolment was from December 2013 – July 2016. The anxiety level was determined using BeckÕs Youth Inventory – Anxiety (BYI-A) (1). Coping strategies were evaluated by a nausea coping questionnaire (NCQ)[1]. MTX-induced nausea was registered by the childrenÕs completion of a nausea diary. The local research ethics committee approved this observational study.

Results: Enrolled were 121 children with JIA (82 girls: 39 boys), the median age (IQR) was 13.3 (11.3-15.1) years. The nausea diary was completed for 1 day by 100 children and for min. 7 days by 77 children. The BYI-A and the NCQ were completed by 119 children. MTX was given orally to 45 patients (MTXO) and subcutaneously to 76 patients (MTXSC). Fifty-six children had MTX-induced nausea deduced from the diaries (MTXO: 16/27; MTXSC: 40/50; p=0.051). The BYI-A raw score was higher for children with self-reported MTX-induced nausea compared to all others (Table 1). The coping strategy internalizing was used more often by children with MTX-induced nausea compared to all others. No significant associations were found for the remaining coping strategies.

Table 1

JIA

p

MTXO: MTXSC, n

45 : 76

MTX dose, median (IQR) mg/m2/week

MTXo : MTXSC

9.7 (9.0 – 10.9)

9.6 (9.0-10.7) : 9.8 (8.8-11.1)

–

0.86

MTX treatment duration, median (IQR) days

MTXo : MTXSC

340 (142-766)

261 (143-543) : 417 (134-853)

–

0.39

BYI-A raw score (total 0 – 60), median (IQR)

MTX-induced nausea: All others (Diary)

26 (22-30)

27 (23-32) : 24 (22-27)

–

0.0164

Coping Strategies, median (IQR)

Internalizing (range 5-25)

MTX-induced nausea: All others (Diary)

Externalizing (range 5-25)

MTX-induced nausea: All others (Diary)

Positive Self Statements (range 5-25)

MTX-induced nausea: All others (Diary)

Information seeking (range 8-40)

MTX-induced nausea: All others (Diary)

Behavioral Distraction (range 4-20)

MTX-induced nausea: All others (Diary)

Cognitive Distraction (range 6-30)

MTX-induced nausea: All others (Diary)

Seeking Social Support (range 6-30

MTX-induced nausea: All others (Diary)

9 (7-12)

10 (8-13) : 7 (5-8)

5 (5-7)

5 (5-7) : 5 (5-6)

15 (11-19)

15 (11-18) : 13 (10-19)

17 (13-21)

17 (14-22) : 16 (14-19)

13 (10-16)

13 (10-16) : 12 (10-18)

21 (18-24)

21 (18-25) : 22 (20-23)

15 (12-20)

16 (13-20) : 16 (12-22)

–

<0.0001

–

0.29

–

0.79

–

0.32

–

0.70

–

0.51

–

0.50

Conclusion: MTX-induced nausea was significantly associated with the coping strategy internalizing and anxiety in children with JIA. These psychological factors need attention when children with JIA commence low-dose MTX treatment, in order to intervene when appropriate.

(1) Thastum M, Ravn K, Sommer S, Trillingsgaard A. Reliability, validity and normative data for the Danish Beck Youth Inventories. Scand J Psychol 2009 Feb;50(1):47-54.



[1] Subscales: Information seeking/problem solving, seeking social support, positive self-statements, behavioural distraction, cognitive distraction, externalizing and internalizing/catastrophizing. Frequency of use: 1=never, 2=hardly ever, 3= sometimes, 4 = often, 5 = very often.


Disclosure: N. Kyvsgaard, None; M. Thastum, None; T. Mikkelsen, None; A. Estmann, None; T. Herlin, None.

To cite this abstract in AMA style:

Kyvsgaard N, Thastum M, Mikkelsen T, Estmann A, Herlin T. Is Methotrexate-Induced Nausea in Juvenile Idiopathic Arthritis Influenced By Anxiety or Coping Strategies? [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/is-methotrexate-induced-nausea-in-juvenile-idiopathic-arthritis-influenced-by-anxiety-or-coping-strategies/. Accessed .
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