Nash Peter, Nicholls Dave
Department of Medicine, University of Queensland, Brisbane, Queensland, Australia; Coast Joint Care, Maroochydore, Queensland, Australia.
Int J Rheum Dis. 2013 Dec;16(6):652-61. doi: 10.1111/1756-185X.12183. Epub 2013 Nov 1.
To improve treatment for rheumatoid arthritis (RA), rheumatologists have embraced patient-reported outcomes; however, limited data are available on patient perceptions of treatment. Our objective was to assess the use and perceptions of methotrexate (MTX) by patients with RA (primary objective) and their rheumatologists, patient-reported adverse events (AEs) related to MTX, and patient-reported use of alcohol, folic acid and biologic agents.
Each rheumatologist completed a rheumatologist questionnaire and then asked patients with RA to complete a patient questionnaire.
Questionnaires were completed by 46/50 rheumatologists and 1313/1313 patients. Patients (72% female, 38% > 10 years RA) took oral MTX regularly (72% never miss a dose) and at therapeutic doses. Most patients (79%) were currently taking MTX, but 36% of patients were on low doses (≤ 10 mg/week) and 8% intentionally and regularly did not take MTX. Most patients had a positive perception of MTX; 82% of patients considered MTX to be important; 60% preferred to continue taking MTX. Although AEs (generally mild and gastrointestinal) occurred regularly (38%) and in some patients continuously (13%), 41% of patients did not experience an AE. Patients abstained from alcohol (46%) and took folic acid (91%, but with variable dosage regimens and doses). There were 29% of patients taking biologic agent therapy; only 70% of these patients were also taking MTX.
MTX was well used, well tolerated and well perceived. However, to ensure that MTX therapy is as effective as possible, rheumatologists should discuss MTX use with their patients and consider alternative strategies for some patients.
为改善类风湿关节炎（RA）的治疗，风湿病学家开始采用患者报告的结局；然而，关于患者对治疗的看法的数据有限。我们的目标是评估RA患者（主要目标）及其风湿病学家对甲氨蝶呤（MTX）的使用和看法、患者报告的与MTX相关的不良事件（AE）以及患者报告的酒精、叶酸和生物制剂的使用情况。
每位风湿病学家完成一份风湿病学家问卷，然后让RA患者完成一份患者问卷。
50位风湿病学家中的46位和1313位患者中的1313位完成了问卷。患者（72%为女性，38%患RA超过10年）定期口服MTX（72%从不漏服一剂）且剂量为治疗剂量。大多数患者（79%）目前正在服用MTX，但36%的患者服用低剂量（≤10毫克/周），8%的患者有意且经常不服用MTX。大多数患者对MTX有积极看法；82%的患者认为MTX很重要；60%的患者更愿意继续服用MTX。尽管AE（一般为轻度且为胃肠道反应）经常发生（38%），在一些患者中持续存在（13%），但41%的患者未经历AE。患者戒酒（46%）并服用叶酸（91%，但剂量方案和剂量各不相同）。有29%的患者接受生物制剂治疗；这些患者中只有70%也在服用MTX。
MTX使用良好、耐受性良好且得到认可。然而，为确保MTX治疗尽可能有效，风湿病学家应与患者讨论MTX的使用，并为一些患者考虑替代策略。
