Haya Almalag, Hanan H Abouzaid, Lamya Alnaim, Jawza Albaqami, Rawan Al Shalhoub, Ibrahim Almaghlouth, Maha Dessougi, Amal Al Harthi, Mohamed Bedaiwi, Eman Alfi, Mohammed A Omair
{"title":"类风湿关节炎患者甲氨蝶呤不耐受的相关危险因素","authors":"Haya Almalag, Hanan H Abouzaid, Lamya Alnaim, Jawza Albaqami, Rawan Al Shalhoub, Ibrahim Almaghlouth, Maha Dessougi, Amal Al Harthi, Mohamed Bedaiwi, Eman Alfi, Mohammed A Omair","doi":"10.2147/OARRR.S263287","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Methotrexate (MTX) Intolerance Severity Score (MISS) has been previously validated in the Arabic language and has helped to detect high levels of intolerance in rheumatoid arthritis (RA) patients. The aim of the current study was to evaluate patient and disease characteristics associated with a high risk of MTX intolerance.</p><p><strong>Materials and methods: </strong>A cross-sectional interview-based survey was conducted using adult RA patients as a study group, who were visiting a specialized rheumatology clinic at King Saud University Medical City. The Arabic MISS was used in this survey. Statistical analyses were performed to understand associations between MTX-intolerant and MTX-tolerant patients.</p><p><strong>Results: </strong>A total of 117 patients were involved in this study. Of those, 101 (86.3%) were females with a mean (SD) disease duration of 6.6 (5.7) years. The median (interquartile range (IQR)) Disease Activity Score-28 (DAS28) was 3.6 (3.6-4.1). MTX intolerance was observed in 55 (47%) patients. The most predominant component in patients with a positive test was the behavioral component. Intolerant patients had a higher median of pain (47.3 vs. 50.0; P = 0.010) and patient global assessment (50.0 vs. 60.0; P = 0.004) scales compared to those in tolerant patients. Additionally, MTX intolerance was associated with the female gender (adjusted odds ratio (AOR) 6.724; 95% CI 1.420, 31.843, P = 0.016), marital status (AOR 2.549; 95% CI 1.037, 6.270, P = 0.042) and DAS28 (AOR 1.612; 95% CI 1.032, 2.517, P = 0.036). There was no significant difference between the two groups in the remaining disease activity parameters, background therapies, seropositivity, and smoking status (P > 0.05).</p><p><strong>Conclusion: </strong>Patient characteristics, rather than disease activity, significantly impact MTX intolerance. Behavioral component is the main driver of intolerance. Intolerant patients have higher patient-reported outcomes. Qualitative studies are needed to explore causes and potential solutions to MTX intolerance.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"12 ","pages":"193-202"},"PeriodicalIF":1.7000,"publicationDate":"2020-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/OARRR.S263287","citationCount":"6","resultStr":"{\"title\":\"Risk Factors Associated with Methotrexate Intolerance in Rheumatoid Arthritis Patients.\",\"authors\":\"Haya Almalag, Hanan H Abouzaid, Lamya Alnaim, Jawza Albaqami, Rawan Al Shalhoub, Ibrahim Almaghlouth, Maha Dessougi, Amal Al Harthi, Mohamed Bedaiwi, Eman Alfi, Mohammed A Omair\",\"doi\":\"10.2147/OARRR.S263287\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Methotrexate (MTX) Intolerance Severity Score (MISS) has been previously validated in the Arabic language and has helped to detect high levels of intolerance in rheumatoid arthritis (RA) patients. The aim of the current study was to evaluate patient and disease characteristics associated with a high risk of MTX intolerance.</p><p><strong>Materials and methods: </strong>A cross-sectional interview-based survey was conducted using adult RA patients as a study group, who were visiting a specialized rheumatology clinic at King Saud University Medical City. The Arabic MISS was used in this survey. Statistical analyses were performed to understand associations between MTX-intolerant and MTX-tolerant patients.</p><p><strong>Results: </strong>A total of 117 patients were involved in this study. Of those, 101 (86.3%) were females with a mean (SD) disease duration of 6.6 (5.7) years. The median (interquartile range (IQR)) Disease Activity Score-28 (DAS28) was 3.6 (3.6-4.1). MTX intolerance was observed in 55 (47%) patients. The most predominant component in patients with a positive test was the behavioral component. Intolerant patients had a higher median of pain (47.3 vs. 50.0; P = 0.010) and patient global assessment (50.0 vs. 60.0; P = 0.004) scales compared to those in tolerant patients. Additionally, MTX intolerance was associated with the female gender (adjusted odds ratio (AOR) 6.724; 95% CI 1.420, 31.843, P = 0.016), marital status (AOR 2.549; 95% CI 1.037, 6.270, P = 0.042) and DAS28 (AOR 1.612; 95% CI 1.032, 2.517, P = 0.036). There was no significant difference between the two groups in the remaining disease activity parameters, background therapies, seropositivity, and smoking status (P > 0.05).</p><p><strong>Conclusion: </strong>Patient characteristics, rather than disease activity, significantly impact MTX intolerance. Behavioral component is the main driver of intolerance. Intolerant patients have higher patient-reported outcomes. 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引用次数: 6
摘要
背景:甲氨蝶呤(MTX)不耐受严重程度评分(MISS)先前已在阿拉伯语中得到验证，并有助于检测类风湿关节炎(RA)患者的高水平不耐受。当前研究的目的是评估与甲氨蝶呤不耐受高风险相关的患者和疾病特征。材料和方法:以沙特国王大学医学城风湿病专科诊所就诊的成年类风湿性关节炎患者为研究对象，采用横断面访谈法进行调查。本调查使用了阿拉伯语的MISS。进行统计分析以了解mtx不耐受和mtx耐受患者之间的关系。结果:本研究共纳入117例患者。其中101例(86.3%)为女性，平均病程(SD)为6.6(5.7)年。疾病活动评分-28 (DAS28)的中位数(四分位间距(IQR))为3.6(3.6-4.1)。55例(47%)患者出现MTX不耐受。在阳性检测的患者中，最主要的成分是行为成分。不耐受患者的疼痛中位数更高(47.3比50.0;P = 0.010)和患者总体评估(50.0 vs. 60.0;P = 0.004)。此外，MTX不耐受与女性相关(调整优势比(AOR) 6.724;95% CI 1.420, 31.843, P = 0.016)，婚姻状况(AOR 2.549;95% CI 1.037, 6.270, P = 0.042)和DAS28 (AOR 1.612;95% ci 1.032, 2.517, p = 0.036)。两组患者其余疾病活动度参数、背景治疗、血清阳性、吸烟状况差异无统计学意义(P > 0.05)。结论:患者特征，而不是疾病活动，显著影响MTX不耐受。行为因素是不容忍的主要驱动因素。不耐受患者报告的结果更高。需要进行定性研究，以探讨MTX不耐受的原因和潜在的解决方案。
Risk Factors Associated with Methotrexate Intolerance in Rheumatoid Arthritis Patients.
Background: Methotrexate (MTX) Intolerance Severity Score (MISS) has been previously validated in the Arabic language and has helped to detect high levels of intolerance in rheumatoid arthritis (RA) patients. The aim of the current study was to evaluate patient and disease characteristics associated with a high risk of MTX intolerance.
Materials and methods: A cross-sectional interview-based survey was conducted using adult RA patients as a study group, who were visiting a specialized rheumatology clinic at King Saud University Medical City. The Arabic MISS was used in this survey. Statistical analyses were performed to understand associations between MTX-intolerant and MTX-tolerant patients.
Results: A total of 117 patients were involved in this study. Of those, 101 (86.3%) were females with a mean (SD) disease duration of 6.6 (5.7) years. The median (interquartile range (IQR)) Disease Activity Score-28 (DAS28) was 3.6 (3.6-4.1). MTX intolerance was observed in 55 (47%) patients. The most predominant component in patients with a positive test was the behavioral component. Intolerant patients had a higher median of pain (47.3 vs. 50.0; P = 0.010) and patient global assessment (50.0 vs. 60.0; P = 0.004) scales compared to those in tolerant patients. Additionally, MTX intolerance was associated with the female gender (adjusted odds ratio (AOR) 6.724; 95% CI 1.420, 31.843, P = 0.016), marital status (AOR 2.549; 95% CI 1.037, 6.270, P = 0.042) and DAS28 (AOR 1.612; 95% CI 1.032, 2.517, P = 0.036). There was no significant difference between the two groups in the remaining disease activity parameters, background therapies, seropositivity, and smoking status (P > 0.05).
Conclusion: Patient characteristics, rather than disease activity, significantly impact MTX intolerance. Behavioral component is the main driver of intolerance. Intolerant patients have higher patient-reported outcomes. Qualitative studies are needed to explore causes and potential solutions to MTX intolerance.
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