title: Perceptions of methotrexate use in rheumatoid arthritis by rheumatologists and their patients: an Australian survey study.
abstract: OBJECTIVE
  To improve treatment for rheumatoid arthritis (RA), rheumatologists have embraced patient-reported outcomes; however, limited data are available on patient perceptions of treatment. Our objective was to assess the use and perceptions of methotrexate (MTX) by patients with RA (primary objective) and their rheumatologists, patient-reported adverse events (AEs) related to MTX, and patient-reported use of alcohol, folic acid and biologic agents.
  
  
  METHODS
  Each rheumatologist completed a rheumatologist questionnaire and then asked patients with RA to complete a patient questionnaire.
  
  
  RESULTS
  Questionnaires were completed by 46/50 rheumatologists and 1313/1313 patients. Patients (72% female, 38% > 10 years RA) took oral MTX regularly (72% never miss a dose) and at therapeutic doses. Most patients (79%) were currently taking MTX, but 36% of patients were on low doses (≤ 10 mg/week) and 8% intentionally and regularly did not take MTX. Most patients had a positive perception of MTX; 82% of patients considered MTX to be important; 60% preferred to continue taking MTX. Although AEs (generally mild and gastrointestinal) occurred regularly (38%) and in some patients continuously (13%), 41% of patients did not experience an AE. Patients abstained from alcohol (46%) and took folic acid (91%, but with variable dosage regimens and doses). There were 29% of patients taking biologic agent therapy; only 70% of these patients were also taking MTX.
  
  
  CONCLUSIONS
  MTX was well used, well tolerated and well perceived. However, to ensure that MTX therapy is as effective as possible, rheumatologists should discuss MTX use with their patients and consider alternative strategies for some patients.
authors.affiliation: Department of Medicine, University of Queensland, Brisbane, Queensland, Australia; Coast Joint Care, Maroochydore, Queensland, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Nash
authors.forename: Dave
authors.initials: D
authors.lastname: Nicholls
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D001291:Attitude of Health Personnel; D001315:Australia; D001688:Biological Products / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D057240:Patient Preference; D010361:Patients / Q000523:psychology*; D010465:Perception; D010820:Physicians / Q000523:psychology*; D012219:Rheumatology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D005492:Folic Acid; D008727:Methotrexate
keywords: arthritis rheumatoid; methotrexate; patient preferences; survey health