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Influence of methotrexate on gastrointestinal symptoms in patients with rheumatoid arthritis
Author(s) -
Asai Shuji,
Nagai Kaoru,
Takahashi Nobunori,
Watanabe Tatsuo,
Matsumoto Takuya,
Asai Nobuyuki,
Sobue Yasumori,
Ishiguro Naoki,
Kojima Toshihisa
Publication year - 2019
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.13380
Subject(s) - medicine , gastroenterology , interquartile range , rheumatoid arthritis , methotrexate , odds ratio , constipation , abdominal pain , indigestion , arthritis , confidence interval , population , diarrhea , environmental health
Aim This study aimed to determine the influence of methotrexate ( MTX ) on gastrointestinal ( GI ) symptoms in patients with rheumatoid arthritis ( RA ). Methods This cross‐sectional study examined 529 consecutive patients with RA receiving oral MTX in our department between April 1 and September 30, 2017. GI symptoms were evaluated by the Gastrointestinal Symptom Rating Scale ( GSRS ); a score of ≥2 was considered “symptomatic.” Prevalence of GI symptoms was compared between patients receiving ≤8 mg/wk (low‐dose) vs >8 mg/wk (high‐dose) of MTX . Results Of our study population, 313 (59%) received low‐dose MTX at a median (interquartile range) dose of 6 (6‐8) mg/wk, whereas 216 (41%) received high‐dose MTX at a median dose of 12 (10‐12) mg/wk. Relative to the low‐dose MTX group, the high‐dose MTX group exhibited a higher prevalence of reflux (32% vs 24%, P = 0.043) and abdominal pain (28% vs 18%, P = 0.007). There was no significant group‐dependent difference in the prevalence of indigestion, diarrhea or constipation. Multivariate logistic regression analysis revealed that high‐dose MTX (>8 mg/wk) was independently associated with reflux (odds ratio [ OR ]: 1.62, 95% confidence interval [ CI ]: 1.07‐2.43) and abdominal pain ( OR : 1.60, 95% CI : 1.04‐2.43), and that the OR s for reflux and abdominal pain among those receiving high‐dose MTX (>8 mg/wk) were similar to those using nonsteroidal anti‐inflammatory drugs. Conclusion High‐dose MTX is independently associated with the prevalence of upper GI symptoms in Japanese patients with RA .