Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

An Audit on Patients' Knowledge of Methotrexate.

Sowden,  Evin, Hassan,  Wajeed, Gooden,  Ann, Jepson,  Bridget, Kausor,  Tamsheela, Shafait,  Ifraz, Brockbank,  John


Methotrexate is a first line disease modifying agent and anchor drug for biologics therapy used in rheumatoid arthritis and other inflammatory rheumatic disorders. Adverse effects may occur in patients and are a common cause of drug discontinuation. Analysis of serious and fatal toxicity incidents led the National Patient Safety Agency (NPSA) to issue an alert identifying patient education and drug monitoring as an important part of a harm reduction strategy. In view of this, we audited patients prescribed methotrexate to assess adherence to patient education and patient knowledge in the rheumatology clinic setting of a district general hospital in the north of England.


All patients prescribed methotrexate for inflammatory rheumatic disease were eligible to take part. A proforma to record clinical and demographic characteristics, provision of patient education and monitoring, knowledge of drug administration, potential side effects and drug interactions was completed by case record review and patient self-administration. Questionnaire answers were discussed and an information leaflet on methotrexate given to the patient at the end of their audit participation.


51 patients were audited. The mean age was 58.6 ±13.1 years and median duration of disease 3.7 (IQR 1.7–7.6) years. Counselling by specialist nurses prior to starting methotrexate was documented in 94.1%, written information was provided in 94%, methotrexate dose and frequency were known to the patient in 84% and 100%, folic acid was co-prescribed in 90% and awareness of pregnancy and breastfeeding risks was 87.5% in females of reproductive age (<45 years). There was limited awareness of methotrexate's mode of action (60%), true side effects (21.6%-62.7%), false side effects (5.9%-37.3%), risks related to alcohol (68.4% in drinkers), risks related to male conception (47.1%), true drug interactions (7.8–11.8%) and false drug interactions (11.8–19.6%). The mean patient global knowledge score was 6.3 ±1.2 on a scale of 0–10 points. Univariate and multivariate analyses identified male gender, non-speakers of english as a first language and a trend toward longer duration of therapy as significant predictors of lower levels of patient knowledge.


Our audit shows that despite systematic patient education interventions as part of routine care, knowledge of important aspects of methotrexate therapy is limited. A number of recommendations are suggested: 1. Use of clearer safety-driven booklets such as that produced by the National Patient Safety Agency (NPSA); 2. Provision of information in languages other than English and in audio or audiovisual formats; 3. Regular knowledge assessments using validated tools; and 4. Targeted education to ensure consistent levels of knowledge to prevent unnecessary methotrexate-related harm.

To cite this abstract, please use the following information:
Sowden, Evin, Hassan, Wajeed, Gooden, Ann, Jepson, Bridget, Kausor, Tamsheela, Shafait, Ifraz, et al; An Audit on Patients' Knowledge of Methotrexate. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :40
DOI: 10.1002/art.27809

Abstract Supplement

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