WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

Kaser Aldow, Akil Hajjouz and Razan Mohammad*

ABSTRACT

Introduction: Methotrexate is the cornerstone in the treatment of Rheumatoid Arthritis. Methotrexate intolerance is frequent, the underlying cause and risk factors are not fully understood. Therefore, this study aimed to determine the prevalence of methotrexate intolerance and its associated risk factors, using the Arabic version of the Methotrexate Intolerance Severity Score Questionnaire. Methods: This cross-sectional study was performed between October 2021 and October 2022, included 105 patients with Rheumatoid Arthritis who were treated with methotrexate, and visited the clinic and division of musculoskeletal diseases at Tishreen University Hospital. Age, sex, smoking, dose, MTX use duration, route of administration and Disease Activity Score for 28joint data were collected. Patients also answered the MISS questionnaire after being explained. Results: Among 105 patients, the prevalence of methotrexate intolerance was 20%, behavioral symptoms were the most common (95%), followed by nausea (90.5%), abdominal pain (42.6%), and finally vomiting (28.6%). The proportion of those who used corticosteroids was greater in MTX intolerance group than in MTX tolerance one (p = 0.001). The risk of MTX intolerance increased with increasing the dose of corticosteroids (odds ratio = 3.4, 95% CI, 1.6–9.8, p = 0.0001). There was also a statistically significant association between higher DAS28 values and the increased risk of MTX intolerance (odds ratio = 2.8, 95% CI, 1.1–7.5, p = 0.008). Conclusion: Corticosteroids use increases the risk of developing MTX intolerance. Severe disease is also associated with MTX intolerance. We advised reducing the dose of corticosteroids as much as possible and controlling disease activity.