Belkis Nihan COSKUN, Burcu YAĞIZ, Yavuz PEHLİVAN, Hüseyin Ediz DALKILIÇ

Romatoid Artrit Hastalarının Metotreksat Kullanımı ile İlgili Farkındalıkları

Çalışmanın amacı, Romatoid artrit (RA) tedavisinde standart ilaç olan metotreksat (MTX) ile ilgili RA hastalarının bilgilerini bir anket aracılığıyla değerlendirmektir. Ağustos-Ekim 2017 tarihinde bir üniversite hastanesinde RA tanısı ile MTX kullanan hastalardan, MTX’in etki mekanizması, uygulama şekli, ilaç etkileşimi, yan etkileri, hastaların izlenme sıklığı ve yapılması gereken yaşam tarzı değişiklikleri ile ilgili soruları içeren anketi yanıtlamaları istendi. Yüz altmış iki hasta (144 kadın) çalışmaya dahil edildi. Ortalama hasta yaşı 52 (18-77), ortalama hastalık süresi 10.3 (1-40) yıl ve ortalama MTX kullanma süresi 7,1 (1-38) yıl idi. MTX’in hastalığı düzenleyen antiromatizmal bir ilaç olduğunu %50 hasta doğru yanıtladı. Uygulama sıklığının haftalık olduğunu %85; folik asid kullanma gerekçesinin, tedavi toksisitesini azaltmak olduğunu ise %19 hasta belirtti ve yine sadece %11’i trimetoprimin kontraendike olduğunu biliyordu. Hematolojik risklerden %11’i haberdardı ve %11’i aşırı duyarlılık pnömonisi riskinin farkındaydı. Laboratuvar testleri ile ilgili %51’inin bilgisi vardı. Doğurganlık çağında kadın ve erkeklerin MTX kullanırken kontrasepsiyon kullanması gerekliliğini bilenler %20 idi. %34’ü alkol tüketiminin sınırlı olması gerektiğini belirtti. Erkekler ve eğitim seviyesi yüksek olanlar istatistiksel olarak daha yüksek oranda doğru cevap verdi (p=0.019, p=0.000). Günlük pratikte RA hastalarında sıklıkla kullanılan MTX hakkında hastaların yetersiz bilgiye sahip olduğu görüldü. Özellikle ciddi yan etkiler, ilaç etkileşimleri ve doğum kontrolü gibi önemli konularda eksiklikler vardı. MTX’e ilişkin hasta bilgisi farklı eğitim araçlarını kullanarak düzenli olarak kontrol edilmeli ve desteklenmelidir.

Anahtar Kelimeler:

Farkındalık, metotreksat, romatoid artrit

Awareness of Rheumatoid Arthritis Patients About Methotrexate Use

The aim of the study is to evaluate the rheumatoid arthritis (RA) patients' knowledge about methotrexate (MTX), the standard drug in the treatment of RA, through a questionnaire. In August-October 2017, patients who used MTX with a diagnosis of RA in a university hospital were asked to answer questionnaire about the mechanism of action of MTX, administration method, drug interaction, side effects, frequency of follow-up of patients and changes to the lifestyle that should be done. One hundred and sixty-two patients (144 women) were included in the study. The mean patient age was 52 (18-77) years, the mean disease duration was 10.3 (1-40) years, and the mean duration of MTX use was 7.1 (1-38) years. 50% of the patients correctly answered that MTX is an anti-inflammatory drug that regulates the disease. 85% of patients correctly responded to the weekly application frequency correctly.; 19% of the patients stated that the reason for using folic acid was to reduce the toxicity of the treatment and again only 11% knew that trimethoprim was contraindicated. 11% were aware of the hematological risks and 11% were aware of the risk of hypersensitivity pneumonia. 51% of them had knowledge about laboratory tests. 20% of women and men of childbearing age knew that they should use contraception while using MTX. 34% stated that alcohol consumption should be limited. Men and those with a high level of education gave a statistically higher rate of correct answers. (p=0.019, p=0.000) It was observed that the patients had insufficient knowledge about MTX, which is frequently used in RA patients in daily practice. There are shortcomings on important issues, especially serious side effects, drug interactions, and birth control. Patient information regarding MTX should be checked and supported regularly by using different training tools.

Keywords:

Awareness, methotrexate, rheumatoid arthritis,

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Referans1. Smolen JS, Landewé R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017. https://doi.org/10.1136/annrheumdis-2016-210715
Referans2. Cannella AC, O’Dell JR. Traditional DMARDs. In: Firestein GS, Budd RC, Gabriel SE, et al (Eds). Kelley and Firestein’s Textbook of Rheu- matology. 10th ed. Philadelphia: Elsevier Inc. 2017. 958-982. Doi:10.1016/b978-0-323-31696- 5.00061-9.
Referans3. Snow MH, Cannella AC. (2019) Systemic Antirheumatic Drugs. West S. (Eds) Rheumatology Sec- rets. 4th E. S. A. D; Philadelphia: Elsevier. 2019. 662-670.
Referans4. Hazlewood GS, Barnabe C, Tomlinson G, et al. Methotrexate monotherapy and methotrexate combination therapy with traditional and biologic disease modifying antirheumatic drugs for rheumatoid arthritis: Abridged cochrane Systematic review and network meta-analysis. BMJ. 2016;353:i1777. https://doi.org/10.1136/bmj.i1777
Referans5. Shea B, Swinden M V., Tanjong Ghogomu E, et al. Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis. Cochrane Database Syst. Rev.2013(5):CD000951.
Referans6. Dalkilic E, Coskun BN, Yağız B, et al. Methotrexate intoxication: Beyond the adverse events. Int J Rheum Dis. 2018:1557-1562. https://doi.org/10.1111/1756-185X.13339
Referans7. Burma MR, Rachow JW, Kolluri S, Saag KG. Methotrexate patient education: A quality improvement study. Arthritis Rheum 1996; 9:216–222. https://doi.org/10.1002/1529-0131(199606)9:3<216::AID-ANR1790090310>3.0.CO;2-5
Referans8. Barton JL, Schmajuk G, Trupin L, et al. Poor knowledge of methotrexate associated with older age and limited English-language proficiency in a diverse rheumatoid arthritis cohort. Arthritis Res Ther 2013;15(5):R157. https://doi.org/10.1186/ar4340
Referans9. Fayet F, Savel C, Rodere M, et al (2016) The development of a questionnaire to evaluate rheumatoid arthritis patient’s knowledge about methotrexate. J Clin Nurs 2016;25:682–689. https://doi.org/10.1111/jocn.12999
Referans10. Sowden E, Hassan W, Gooden A, et al. Limited end-user knowledge of methotrexate despite patient education: An assessment of rheumatologic preventive practice and effectiveness. J Clin Rheumatol 2012;18:130–133. https://doi.org/10.1097/RHU.0b013e31824e1e63
Referans11. Kessels RPC. Patients’ Memory for Medical Information. J R Soc Med 2003;96:219–222. https://doi.org/10.1177/014107680309600504
Referans12. Salliot C, Van Der Heijde D. Long-term safety of methotrexate monotherapy in patients with rheumatoid arthritis: A systematic literature research. Ann Rheum Dis 2009;68:1100–1104. https://doi.org/10.1136/ard.2008.093690
Referans13. Kivity S, Zafrir Y, Loebstein R, et al. Clinical characteristics and risk factors for low dose methotrexate toxicity: A cohort of 28 patients. Autoimmun Rev 2014;13:1109–1113. https://doi.org/10.1016/j.autrev.2014.08.027