title: Poor knowledge of methotrexate associated with older age and limited English-language proficiency in a diverse rheumatoid arthritis cohort.
abstract: BACKGROUND
  Our objective was to determine rheumatoid arthritis (RA) patients' understanding of methotrexate and assess whether knowledge varies by age, education, English language proficiency, or other disease-related factors.
  
  
  METHODS
  Adults with RA (n = 135) who were enrollees of an observational cohort completed a structured telephone interview in their preferred language between August 2007 and July 2009. All subjects who reported taking methotrexate were asked 11 questions about the medication in addition to demographics, education level, and language proficiency. Primary outcome was a total score below the 50th percentile (considered inadequate methotrexate knowledge). Bivariable and multivariable logistic regressions were performed. Covariates included demographics, language proficiency, education, and disease characteristics.
  
  
  RESULTS
  Of 135 subjects, 83% were female, with a mean age of 55 ± 14 years. The majority spoke English (64%), followed by 22% Spanish and 14% Cantonese or Mandarin. Limited English language proficiency (LEP) was reported in 42%. Mean methotrexate knowledge score was 5.4 ± 2.6 (range, 0 to 10); 73 (54%) had a score lower than 5 (of 10). Age older than 55, less than high school education, LEP, better function, and biologic use were independently associated with poor knowledge.
  
  
  CONCLUSIONS
  In a diverse RA cohort, overall methotrexate knowledge was poor. Older age and limited proficiency in English were significant correlates of poor knowledge. Identification of language barriers and improved clinician-patient communication around methotrexate dosing and side effects may lead to improved safety and enhanced benefits of this commonly used RA medication.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Barton
authors.forename: Gabriela
authors.initials: G
authors.lastname: Schmajuk
authors.forename: Laura
authors.initials: L
authors.lastname: Trupin
authors.forename: Jonathan
authors.initials: J
authors.lastname: Graf
authors.forename: John
authors.initials: J
authors.lastname: Imboden
authors.forename: Edward H
authors.initials: EH
authors.lastname: Yelin
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D015331:Cohort Studies; D003144:Communication Barriers; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D007802:Language; D016015:Logistic Models; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D019303:Multilingualism; D015999:Multivariate Analysis; D064887:Observational Studies as Topic
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate