title: Mothers' reports of the difficulties that their children experience in taking methotrexate for Juvenile Idiopathic Arthritis and how these impact on quality of life.
abstract: BACKGROUND
  Children who take methotrexate for juvenile idiopathic arthritis may experience side effects, including nausea and vomiting, leading to anticipatory nausea in some children, and fear of injections or blood tests. The aim of this study was to examine the prevalence and extent of these difficulties and their impact on quality of life.
  
  
  METHODS
  Participants were mothers of children with JIA who were currently taking methotrexate (MTX). Mothers completed a questionnaire about MTX that was developed for the study, two questions from the treatment subscale of the Pediatric Quality of Life Inventory (PedsQL) Rheumatology scale to assess needle-related problems and the Child Health Questionnaire 50-item parent version (CHQ-PF50) to assess health-related quality of life (HRQoL).
  
  
  RESULTS
  171 mothers participated in the study. More than half of children were reported to have experienced one or more of: nausea or vomiting after taking MTX, anticipatory nausea, fear of blood tests or fear of injections. There was no significant difference in reported rates of sickness or needle-related problems between MTX responders (ACR70 or above), partial responders (ACR30 or ACR50) and non-responders. In multivariate analyses, variables that were significant independent predictors of one or more MTX-related difficulties included younger age, taking MTX subcutaneously and having a larger number of currently active joints. Feeling sick after taking MTX was a significant independent predictor of poorer scores on the physical summary scale of the CHQ-PF50. Anxiety about injections and feeling sick after taking MTX were significant independent predictors of poorer scores on the psychosocial summary scale.
  
  
  CONCLUSIONS
  Difficulties in taking MTX are experienced by a significant proportion of children with JIA and these may have an adverse impact on HRQoL. Approaches to help minimize these difficulties are required.
authors.affiliation: School of Health Sciences, City University London, Northampton Square, London, EC1V OHB, UK. Stanton.Newman.1@city.ac.uk.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Mulligan
authors.forename: Laura
authors.initials: L
authors.lastname: Kassoumeri
authors.forename: Angela
authors.initials: A
authors.lastname: Etheridge
authors.forename: Halima
authors.initials: H
authors.lastname: Moncrieffe
authors.forename: Lucy R
authors.initials: LR
authors.lastname: Wedderburn
authors.forename: Stanton
authors.initials: S
authors.lastname: Newman