Prevalence of methotrexate intolerance among patients with rheumatoid arthritis in Erbil city using methotrexate intolerance severity score

Background and objectives: Rheumatoid arthritis is classified as an autoimmune disease characterized by inflammation of the joints and membranes surrounding the joints. The aim of this study was to find the frequency of methotrexate intolerance among rheumatoid arthritis patients and to detect factors contributing to intolerance. Methods: An observational cross-sectional study was conducted in Rizgary and Hawler Teaching Hospital in Erbil/ Iraq. The study period started from the 1st of July 2021 to the 1st of July 2022. A convenient sample of hundred patients was included in the study. A validated version of the methotrexate intolerance severity score questionnaire was used for data collection. Each element in the methotrexate intolerance severity score questionnaire was given a score ranging from 0-3 depending on the absence of symptoms or the presence of mild, moderate or severe symptoms. The intolerance was diagnosed based on a cut-off score of 6 and more. Results: Females constituted 93% of the sample, 49% were obese, and only 13% were smokers. Among the rheumatoid arthritis patients, 66% tolerated Methotrexate, and only 34% did not tolerate the treatment. The oral dose was tolerated by 71%, and the only significant relation(p=0.050) was reported for the route of Methotrexate administration. The differences were significant for restlessness (p<0.001), crying (p=0.002), irritability(p<0.001), and not taking medication. Conclusions: The study concluded that Methotrexate intolerance is prevalent among Rheumatoid arthritis patients in Erbil city. The prevalence of intolerance was significant among steroid users.