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
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JIA
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p
|
|
MTXO: MTXSC, n
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45 : 76
|
|
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MTX dose, median (IQR) mg/m2/week MTXo : MTXSC
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9.7 (9.0 – 10.9) 9.6 (9.0-10.7) : 9.8 (8.8-11.1) |
– 0.86 |
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MTX treatment duration, median (IQR) days MTXo : MTXSC
|
340 (142-766) 261 (143-543) : 417 (134-853) |
– 0.39 |
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BYI-A raw score (total 0 – 60), median (IQR) MTX-induced nausea: All others (Diary)
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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.
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 .ACR Meeting Abstracts - https://acrabstracts.org/abstract/is-methotrexate-induced-nausea-in-juvenile-idiopathic-arthritis-influenced-by-anxiety-or-coping-strategies/