German Center for Pediatric Rheumatology, Garmisch-Partenkirchen, Germany.
Center for Pain Treatment in Young People, Garmisch-Partenkirchen, Germany.
Pediatr Rheumatol Online J. 2024 Oct 24;22(1):95. doi: 10.1186/s12969-024-01024-9.
Methotrexate (MTX) intolerance in juvenile idiopathic arthritis (JIA) frequently leads to discontinuation due to anticipatory and associative gastrointestinal symptoms. Eye Movement Desensitization and Reprocessing (EMDR) has successfully been used in MTX intolerance, with lasting effects but frequently diminishing efficacy over time. BLAST (bi-lateral alternating stimulation tactile) wristbands utilize a similar process to EMDR. The aim of this study was to determine if utilization of BLAST wristbands could improve and prolong the effect of EMDR on patients with MTX intolerance.
Consecutive patients admitted to the German Center for Pediatric and Adolescent Rheumatology with JIA and signs of MTX intolerance from October 2016 until March 2024 were included in this study. Treatment was performed using an adapted 8 phase EMDR protocol implementing BAST wristbands. Initial patients were treated with EMDR, subsequent patients additionally with BLAST wristbands. Health-related quality of live was determined using the PedsQL. Measurements of MISS (Methotrexate Intolerance Severity Score) and PedsQL were taken at 4 time points: directly before and after (MISS only) treatment, as well as 4 and 12 months after treatment. Changes in MISS and PedsQL were compared using descriptive statistics and repeated measures ANOVA.
87 patients with MTX intolerance were included, 53 in group 1 without BLAST wristbands and 34 in group 2 which were concurrently treated with BLAST wristbands. All patients reported marked improvement of MTX intolerance symptoms (mean MISS score group 1: 15.0 ± 5.5 before treatment, 1.3 ± 1.5 after treatment, group 2: 16.8 ± 5.6 and 2.5 ± 2.5, respectively). After 4 and 12 months, MISS in group 1 was 8.1 ± 7.1 and 8.7 ± 8.4, and in group 2: 7.1 ± 6.3 and 6.5 ± 5.7. A repeated measures ANOVA showed a significant difference between the MISS results over time (F(3,114) = 64.6, p < 0.001), and also demonstrated a significant difference of the PedsQL results between the two groups over time (F(2,64) = 8.9, p < 0.001).
Treatment with Eye Movement Desensitization and Reprocessing (EMDR) could present an effective treatment of MTX intolerance, and using BLAST wristbands, further potential improvement is possible.
甲氨蝶呤（MTX）不耐受在幼年特发性关节炎（JIA）中很常见，由于预期和关联的胃肠道症状，常导致停药。眼动脱敏再处理（EMDR）已成功用于 MTX 不耐受，具有持久的效果，但随着时间的推移，效果逐渐减弱。BLAST（双侧交替刺激触觉）腕带利用类似的过程来进行 EMDR。本研究旨在确定 BLAST 腕带的使用是否可以改善和延长 EMDR 对 MTX 不耐受患者的疗效。
连续纳入 2016 年 10 月至 2024 年 3 月期间德国儿科和青少年风湿病中心 JIA 并出现 MTX 不耐受迹象的患者。治疗采用改良的 8 阶段 EMDR 方案，使用 BAST 腕带。初始患者接受 EMDR 治疗，随后患者同时接受 BLAST 腕带治疗。采用 PedsQL 评估健康相关生活质量。在 4 个时间点测量 MISS（甲氨蝶呤不耐受严重程度评分）和 PedsQL：治疗前和治疗后直接（仅 MISS），以及治疗后 4 个月和 12 个月。使用描述性统计和重复测量方差分析比较 MISS 和 PedsQL 的变化。
共纳入 87 例 MTX 不耐受患者，其中 53 例在未使用 BLAST 腕带的第 1 组，34 例在同时使用 BLAST 腕带的第 2 组。所有患者均报告 MTX 不耐受症状明显改善（第 1 组平均 MISS 评分：治疗前 15.0±5.5，治疗后 1.3±1.5；第 2 组：16.8±5.6 和 2.5±2.5）。治疗后 4 个月和 12 个月，第 1 组 MISS 分别为 8.1±7.1 和 8.7±8.4，第 2 组分别为 7.1±6.3 和 6.5±5.7。重复测量方差分析显示，MISS 结果随时间的差异具有统计学意义（F（3,114）=64.6，p<0.001），两组间 PedsQL 结果随时间的差异也具有统计学意义（F（2,64）=8.9，p<0.001）。
眼动脱敏再处理（EMDR）治疗可能是 MTX 不耐受的有效治疗方法，使用 BLAST 腕带可能进一步提高疗效。
