title: Tolerability and Adherence Problems in Patients on a Stable Dose of Methotrexate: Results of a Multicentre Survey.
abstract: Methotrexate is commonly used in patients with inflammatory arthritis. The aim of the present study was to ascertain the prevalence of side effects that patients on methotrexate were tolerating and to establish their adherence to the medication.
  
  
  
  A questionnaire was developed for completion by the healthcare professional with the patient, and piloted in one centre. The questionnaire was then used in six other centres, with the addition of a question about the attractiveness of stopping methotrexate treatment. Efficacy and toxicities were scored for severity on a 10-cm visual analogue scale (VAS). Adherence to the drug was also explored.
  
  
  
  The prevalence of 'any side effect' ranged from 57% to 86%. The most frequent side effects were fatigue (53%); nausea (38%); mouth ulcers (23%) and hair loss (23%). Efficacy averaged 6.5 cm on the VAS. Results from the combined survey revealed that toxicity averaged 5.9 cm for fatigue, 4.8 cm for nausea, 4.4 for mouth ulcers, 3.9 cm for hair loss and 5.7 cm for 'other' side effects. 13.5% of patients revealed that they had forgotten to take the drug for an average of two weeks, and 25% for an average of 2.5 weeks in the previous year. Participants were more likely to reveal this to a nurse than a doctor.
  
  
  
  Patients put up with a considerable number of side effects in order to benefit from methotrexate therapy. Adherence to this drug merits further study. Copyright © 2015 John Wiley & Sons, Ltd.
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK. Sandra.robinson3@nhct.nhs.uk.
authors.forename: S
authors.initials: S
authors.lastname: Robinson
authors.affiliation: Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK.
authors.forename: S
authors.initials: S
authors.lastname: Gibson
authors.affiliation: Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK.
authors.forename: E
authors.initials: E
authors.lastname: George
authors.affiliation: Waterford Regional Hospital, Waterford, Ireland.
authors.forename: U
authors.initials: U
authors.lastname: Martin
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK.
authors.forename: P
authors.initials: P
authors.lastname: Heslop
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK.
authors.forename: H
authors.initials: H
authors.lastname: Wrightson
authors.affiliation: Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK.
authors.forename: P
authors.initials: P
authors.lastname: Prowse
authors.affiliation: Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK.
authors.forename: M
authors.initials: M
authors.lastname: Kalinowski
authors.affiliation: Inverclyde Royal Hospital, NHS Greater Glasgow and Clyde, Greenock, UK.
authors.forename: D
authors.initials: D
authors.lastname: Marshall
authors.affiliation: Inverclyde Royal Hospital, NHS Greater Glasgow and Clyde, Greenock, UK.
authors.forename: M
authors.initials: M
authors.lastname: Reed
authors.affiliation: The University of Sheffield, Sheffield, UK.
authors.forename: A
authors.initials: A
authors.lastname: Adebajo
authors.affiliation: Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
authors.forename: D
authors.initials: D
authors.lastname: Walker
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects*; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects*; D010865:Pilot Projects; D016903:Drug Monitoring
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate
keywords: Methotrexate; adherence; side effects; tolerance