FREQUENCY OF METHOTREXATE INTOLERANCE IN JUVENILE IDIOPATHIC ARTHRITIS PATIENTS (JIA): AN EXPERIENCE USING METHOTREXATE INTOLERANCE SEVERITY SCORE (MISS)

Frequency of Methotrexate Intolerance

Abstract

Objective: To determine frequency of methotrexate (MTX) intolerance using Methotrexate Intolerance Severity Score (MISS) in patients with Juvenile Idiopathic Arthritis (JIA).
Study Design: Descriptive study.
Place and Duration: Rheumatology Department of Pakistan Institute of Medical Sciences Islamabad from July 2011 to May 2012.
Patients and Methods: Patients of either sex, less than 16 years of age, visiting the Rheumatology outpatient department with JIA were included by non probability purposive sampling. All patients were prescribed MTX in an oral dose of 0.5mg/kg body weight per week for three months. MISS was applied. MISS is a 4 item questionnaire, inquiring about abdominal ache, nausea, vomiting and behavioral symptoms while taking MTX. For every question the patient is given a score. A score of 0 means no complaints, 1 point means mild, 2 point means moderate and 3 points means severe. The minimum possible total score on MISS is 0 point and a maximum is 36 points. A cutoff score of 6 or above was taken as intolerance as judged by the team.
Results: A total of 100 patients/parents completed the MISS questionnaire. Forty percent patients showed MTX intolerance and nausea, abdominal pain, vomiting and behavioral symptoms were observed in majority of the patients.
Conclusion: MISS questionnaire was found simple to administer. Forty percent patients were found intolerant.