Saif Saba, Kakalia Spenta, Kitchlew Rizwana, Khan Haseeb Ahmed, Fida Samina, Siddique Muhammad
Department of Medicine, CMH Lahore Medical College and Institute of Dentistry, Lahore Cantt, Pakistan.
Department of Pediatrics, CMH Lahore Medical College and Institute of Dentistry, Lahore Cantt, Pakistan.
J Coll Physicians Surg Pak. 2022 Oct;32(10):1308-1312. doi: 10.29271/jcpsp.2022.10.1308.
To determine the frequency of intolerance to Methotrexate (MTX) in patients with inflammatory arthritis by using MTX intolerance severity score, and evaluate the effects of Ondansetron in reducing MTX intolerance.
Interventional study.
Rheumatology clinic, Combined Military Hospital (CMH), Lahore, from 1st November 2021 to 30th April 2022.
Patients with inflammatory arthritis taking methotrexate regularly for >3 months participated in the study. The patients' age, gender, education level, marital status and smoking history were documented. The disease duration and disease activity was also recorded. Dose/duration/route/frequency and timing of MTX were noted. MTX intolerance was calculated with the use of the Methotrexate intolerance severity score (MISS) questionnaire. Those MTX intolerant patients who reported nausea and vomiting were prescribed ondansetron along with MTX and were followed up for the next 3 consecutive months.
Out of 181 patients, 48(26.5%) showed methotrexate intolerance. The predominant symptom was nausea after taking MTX reported in 93.8% of the MTX intolerant patients followed by behavioural symptoms including restlessness and irritability reported among 79% and 77% of intolerant patients respectively. Those methotrexate intolerant patients who mainly had complaints of nausea and vomiting were started on ondansetron on the day of methotrexate and showed a significant reduction in the median of MISS score in the following two consecutive months (p <0.05) while at 3 months the median did not show further reduction as compared to second month (p=0.12).
Ondansetron prescribed along with methotrexate in patients having complaints of nausea and vomiting with MTX, reduces the intolerance significantly.
Rheumatoid arthritis, Methotrexate, Ondansetron, Nausea, Arthritis juvenile.
通过使用甲氨蝶呤不耐受严重程度评分来确定炎症性关节炎患者对甲氨蝶呤（MTX）不耐受的频率，并评估昂丹司琼在减轻MTX不耐受方面的效果。
干预性研究。
2021年11月1日至2022年4月30日，拉合尔联合军事医院（CMH）的风湿病诊所。
定期服用甲氨蝶呤超过3个月的炎症性关节炎患者参与本研究。记录患者的年龄、性别、教育程度、婚姻状况和吸烟史。还记录疾病持续时间和疾病活动度。记录MTX的剂量/持续时间/途径/频率和服用时间。使用甲氨蝶呤不耐受严重程度评分（MISS）问卷计算MTX不耐受情况。那些报告有恶心和呕吐的MTX不耐受患者在服用MTX的同时服用昂丹司琼，并连续随访3个月。
在181名患者中，48名（26.5%）表现出对甲氨蝶呤不耐受。主要症状是服用MTX后恶心，93.8%的MTX不耐受患者报告有此症状，其次是行为症状，分别有79%和77%的不耐受患者报告有不安和易怒。那些主要有恶心和呕吐主诉的甲氨蝶呤不耐受患者在服用甲氨蝶呤当天开始服用昂丹司琼，在接下来的连续两个月中MISS评分中位数显著降低（p<0.05），而在第3个月时，中位数与第二个月相比没有进一步降低（p=0.12）。
对于有MTX引起的恶心和呕吐主诉的患者，在服用甲氨蝶呤时同时服用昂丹司琼可显著降低不耐受情况。
类风湿性关节炎；甲氨蝶呤；昂丹司琼；恶心；青少年关节炎
