Background/Purpose: Methotrexate (MTX) is the cornerstone for the treatment of RA as monotherapy or in combination. While its cost effectiveness in halting the disease is inarguable, many obstacles hinder optimal usage. Myths about MTX, for example, that it is chemotherapy, often lead to fear of side effects and reluctance to accept treatment. While intolerance to MTX has been widely reported, it is known that the subcutaneous administration route is more efficacious than oral and usually better tolerated. Unfortunately, this preferred route is not routinely used based on the belief that self-administration is impractical and unsafe. In our interprofessional arthritis care program, we provide holistic education on disease, medication options and self-management strategies right from the time of diagnosis. Our pharmacists teach subcutaneous self-injection of both MTX and Vitamin B12. In this questionnaire study, we aim to determine patient experience with using MTX with the support of an interprofessional arthritis care team.

Methods: We reviewed and modified, with permission, a survey developed by a national patient advocacy group, adding questions about patient attendance at the interprofessional arthritis care program and whether they have accessed the pharmacist consultation service. The questionnaire, asking for anonymous data only, was administered in hardcopy format to consecutive patients visiting our clinic and the four off-site rheumatologist offices. All patients who have ever used MTX for managing inflammatory arthritis were eligible to participate. Office staff and allied health providers identified eligible participants and provided a study envelope which contained the study participant information letter and the questionnaire. Participants were asked to return the completed questionnaire in a sealed envelope before they left.

Results: Over an 8 week period, a total of 228 completed surveys were received.

Table 1. Study Participants Characteristics (n = 228):

Over 80% of survey respondents stated they feel MTX helps their arthritis. Only 13% of respondents reported they stopped MTX due to side effects, with nausea and fatigue being most common. It should be noted that 61% of respondents were taking Vitamin B12, with 52% of those using the subcutaneous injection route. Among those using Vitamin B12, 60% believe that it helped reduce the side effects of MTX.

Conclusion: Our survey results suggest long survival of subcutaneous MTX administration. Further study is warranted to explore possible benefits of Vitamin B12 co-prescription and the impact of interprofessional care model on patient experience with MTX use in inflammatory arthritis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/user-experience-with-methotrexate-in-managing-inflammatory-arthritis-under-the-support-of-an-interprofessional-arthritis-care-team-umtx-study/