Assessing methotrexate intolerance and its prevalence in rheumatoid arthritis: Development and validation of the MISA questionnaire

Vijaykumar, Deeksha; Dhir, Varun; Jain, Siddharth; Vs, Pai; Kaur, Jaswinder; Naidu, Gsrsnk; Sharma, Aman; Sharma, Shefali; Jain, Sanjay

doi:10.1111/1756-185x.14207

Cited by 7 publications

(9 citation statements)

References 35 publications

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“…This may be one of the reasons why adherence is only 50%-94% at 1 year and 25%-79% at 5 years (42). Intolerance to methotrexate was associated with younger age, as reported elsewhere (41)(43)(44). In our study, fewer patients with D2T RA took methotrexate than in the non–D2T RA group.…”

Section: Discussionsupporting

confidence: 80%

Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease

León

Madrid

Lopez-Viejo

et al. 2022

Preprint

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Objectives. Most studies on difficult-to-treat rheumatoid arthritis (D2T RA) have focused on established RA. Here, we analyze whether disease activity in the early stages of RA could influence progression to a D2T RA under real-life conditions. Other clinical and treatment-related factors were also analyzed. Methods. A longitudinal multicenter study of RA patients was conducted from 2009 to 2018. Patients were followed up until January 2021. D2T RA was defined based on EULAR criteria (treatment failure, signs suggestive of currently active/progressive disease, and management being perceived as problematic by the rheumatologist and/or patient). The main outcome was disease activity in the early stages. The covariates were sociodemographic, clinical, and treatment-related factors. We ran a multivariable logistic regression analysis to investigate risk factors associated with progression to D2T RA. Weighting techniques were also applied to balance data. Results. The study population comprised 631 patients and 35 developed D2T RA. At the time of diagnosis, the D2T RA group were younger, with a higher disability, DAS28 score, tender joint count and pain scores. In our final model, DAS28 was not statistically significantly associated with D2T RA. No differences were found between groups for therapy. Disability was independently associated with D2T RA (OR: 1.50; p=0.02). Conclusions. In this cohort of patients newly diagnosed with RA, our results do not allow us to prove the influence of active disease according to DAS28. However, we did find that patients with elevated initial disability scores are more likely to develop D2T RA regardless of other factors.

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Section: Discussionsupporting

confidence: 80%

Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease

León

Madrid

Lopez-Viejo

et al. 2022

Preprint

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“…This may be one of the reasons why adherence is only 50%–94% at 1 year and 25%–79% at 5 years 44. Intolerance to methotrexate was associated with younger age, as reported elsewhere 43 45 46. In our study, fewer patients with D2T RA took methotrexate than in the non-D2T RA group.…”

Section: Discussionsupporting

confidence: 62%

Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease

et al. 2023

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ObjectivesMost studies on difficult-to-treat rheumatoid arthritis (D2T RA) have focused on established RA. Here, we analyse whether disease activity in the early stages of RA could influence progression to a D2T RA under real-life conditions. Other clinical and treatment-related factors were also analysed.MethodsA longitudinal multicentre study of patients with RA was conducted from 2009 to 2018. Patients were followed up until January 2021. D2T RA was defined based on EULAR criteria (treatment failure, signs suggestive of currently active/progressive disease and management being perceived as problematic by the rheumatologist and/or patient). The main variable was disease activity in the early stages. The covariates were sociodemographic, clinical and treatment-related factors. We ran a multivariable logistic regression analysis to investigate risk factors associated with progression to D2T RA.ResultsThe study population comprised 631 patients and 35 (5.87%) developed D2T RA. At the time of diagnosis, the D2T RA group were younger, with a higher disability, 28-joint Disease Activity Score (DAS28) score, tender joint count and pain scores. In our final model, DAS28 was not statistically significantly associated with D2T RA. No differences were found between groups for therapy. Disability was independently associated with D2T RA (OR: 1.89; p=0.01).ConclusionsIn this cohort of patients newly diagnosed with RA, our results do not allow us to prove the influence of active disease according to DAS28. However, we did find that younger patients and those with elevated initial disability scores are more likely to develop D2T RA regardless of other factors.

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“…The patients with less than three points of MISA-CP score were defined as mild MTX intolerance, and those with more than four were evaluated as moderate-to-severe MTX intolerance. 16 Additional data collected from institutional medical records were age, sex, disease duration, time of MTX use, dose, concomitant medications, laboratory data (creatinine, estimated glomerular filtration rate, aspartate aminotransferase, alanine aminotransferase, platelet, and C-reactive protein), other comorbidities, and visual analog scale (VAS) and disease activity as assessed by Clinical Disease Activity Index (CDAI) 20 and Simple Disease Activity Index (SDAI) 21 at the time of MISA questionnaire. First, the patients were classified into two groups with or without MTX intolerance based on the MISA score.…”

Section: Patient Eligibility and Assessmentmentioning

confidence: 99%

“…Patients diagnosed with RA according to the American College of Rheumatology (ACR) 1987 revised criteria 18 or ACR/European League Against Rheumatism (EULAR) 2010 criteria 19 in regular use of oral MTX were invited to answer MISA questionnaire. 16 Patients with psychiatric illnesses and seemed unable to answer the questionnaire correctly (i.e., due to dementia) were excluded. All patients were over 18 years old and Japanese.…”

Section: Patient Eligibility and Assessmentmentioning

confidence: 99%

“…MTX intolerance among different ethnicities has been reported to be 22%-42%. [11][12][13][14] The PROs are Methotrexate Intolerance Severity Score (MISS), 15 developed for juvenile RA, or the Methotrexate Intolerance and Severity assessment in Adults (MISA), 16 modified for adults. MISS greatly emphasizes anticipatory and associative symptoms, such as restlessness and crying when taking MTX, which are less common in adults.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of oral methotrexate intolerance in Japanese adult patients with rheumatoid arthritis

Kanda,

Sato,

Nagahata

et al. 2024

Int J of Rheum Dis

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AimThe objective of this study was to assess the gastrointestinal side (GI) effects of oral methotrexate (MTX) in Japanese adult patients with rheumatoid arthritis (RA).MethodsIn this single‐center retrospective study, 112 Japanese adult patients (over 18 years old) with RA were examined by Methotrexate Intolerance and Severity assessment in Adults (MISA) questionnaire.ResultsForty‐five (40.2%) of patients were MTX intolerant (MISA score ≥1). Twelve patients (11.2%) were moderate‐to‐severe MTX intolerant (MISA cross‐product score ≥4). The most common GI side effects of MTX were gastric discomfort (26.8%), followed by loss of appetite or dysgeusia (14.3%), fatigue and lethargy (12.5%), and nausea (10.7%).ConclusionsJapanese adult patients with RA showed a high prevalence of MTX intolerance even in low‐dose oral MTX. The MISA questionnaire was practical for finding patients with MTX intolerance.

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Assessing methotrexate intolerance and its prevalence in rheumatoid arthritis: Development and validation of the MISA questionnaire

Cited by 7 publications

References 35 publications

Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease

Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease

Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease

Assessment of oral methotrexate intolerance in Japanese adult patients with rheumatoid arthritis

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