Methotrexate intolerance in rheumatoid arthritis Save

Methotrexate (MTX) is the most commonly used DMARD in rheumatoid arthritis (RA); however, there is significant intolerance to this drug among adult RA patients - especially at doses above 15 mg per week. 

A cross- sectional, single center study from India included RA patients on regular oral or subcutaneous MTX for a lease three months. Patients were surveyed using the methotrexate intolerance severity score (MISS) questionnaire. Patients with a MISS score ≥ 6 were considered MTX intolerant. Intolerance was correlated with clinical variables and disease activity (DAS-28 CRP). 

Among a total o f200 adult RA patients (86% female), the average duration of MTX use was 46 months. 

• MTX intolerance was observed in nearly 35% - Nausea (85.5%) and GI discomfort (59.42%) were the most prevalent symptoms. 
  • nausea was a predominant symptom not only after MTX administration but also as an anticipatory and associative symptom
• MTX intolerance was correlated with female gender, disease severity, and MTX dose. 42-48% were MTX intolerant with the DAS28-CRP > 3.2

MTX doses of 15 mg/week or greater may be associated with intolerance. 

This study did not evaluate the effects of folate supplementation on intolerance.