Paediatric and Adolescent Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
Department of Psychology and Behavioural Sciences, Aarhus BSS, Aarhus University, Aarhus, Denmark.
PLoS One. 2019 Jul 11;14(7):e0219539. doi: 10.1371/journal.pone.0219539. eCollection 2019.
To analyse the internal consistency of an adaption of the methotrexate intolerance severity score (MISS); and to describe and compare the level of methotrexate intolerance evaluated by the MISS in Danish children with juvenile idiopathic arthritis (JIA) or acute lymphoblastic leukaemia (ALL), treated with low-dose methotrexate (MTX).
Cross-sectional study of children diagnosed with JIA or ALL, treated with low-dose MTX, aged 9 years or above, and cognitively intact. The patient's parents completed the MISS. MTX intolerance was defined as a total MISS score above 6.
We enrolled 120 children with JIA and 23 children with ALL. The MISS had a good internal consistency in the JIA group. The median MISS score was higher in the JIA group than in the ALL group (JIA: 8; ALL: 1; p<0.0001); and the JIA group had a larger proportion of MTX intolerant children than the ALL group (JIA: 73/120; ALL: 4/23; p<0.001). Within both the JIA group and the ALL group, the MISS total score was not significantly correlated with age, MTX dose or the duration of low-dose MTX treatment.
In the JIA group the level of MTX intolerance was higher and more attributed to anticipatory, associative and behavioural symptoms than in the ALL group. The MISS may help to uncover whether MTX intolerance is present and which aspects are affected in the individual patient, thus guiding intervention. The MISS may also be applicable within leukaemia care.
分析甲氨蝶呤不耐受严重程度评分（MISS）的内部一致性；描述并比较丹麦幼年特发性关节炎（JIA）或急性淋巴细胞白血病（ALL）接受低剂量甲氨蝶呤（MTX）治疗的儿童用 MISS 评估的甲氨蝶呤不耐受程度。
对接受低剂量 MTX 治疗、年龄在 9 岁及以上且认知完整的 JIA 或 ALL 患儿进行横断面研究。患儿的父母完成 MISS。甲氨蝶呤不耐受定义为 MISS 总分超过 6 分。
我们共纳入了 120 例 JIA 患儿和 23 例 ALL 患儿。MISS 在 JIA 组中具有良好的内部一致性。JIA 组的 MISS 评分中位数高于 ALL 组（JIA：8；ALL：1；p<0.0001）；JIA 组中甲氨蝶呤不耐受的患儿比例高于 ALL 组（JIA：73/120；ALL：4/23；p<0.001）。在 JIA 组和 ALL 组中，MISS 总分均与年龄、MTX 剂量或低剂量 MTX 治疗持续时间无显著相关性。
在 JIA 组中，MTX 不耐受的程度更高，更多归因于预期、关联和行为症状，而非 ALL 组。MISS 可能有助于发现是否存在 MTX 不耐受以及个体患者的哪些方面受到影响，从而指导干预。MISS 也可能适用于白血病治疗。
