Background In recent years, early aggressive targeted treatment for inflammatory joint diseases such as rheumatoid arthritis (RA) is recommended. Low dose Methotrexate (LD-MTX) is the “anchor drug” for RA and other inflammatory arthritidies. The administration of LD-MTX using subcutaneous route increases its therapeutic efficacy, ensures the maximum bioavailability and reduces gastrointestinal adverse effects. Therefore, it is preferred over the oral route. However, the acceptability of the injectable form of LD-MTX has several hurdles including fear of discomfort associated with the injection. This study tried to find out the factor(s) that directly influence the learning capabilities of patients with rheumatological diseases.
Objectives To find out the factors influencing the learning ability of self-injection technique among patients with inflammatory rheumatic diseases.
Methods This retrospective study included patients who were prescribed injectable LD-MTX for their treatment. Besides the demographic information (age, gender) and disease characteristics (diagnosis, duration, prior treatment), the patients were interviewed and counselled regarding the virtues of LD-MTX self-injection. Various other aspects including family and social support, educational background that could influence the learning ability of self-injection techniques were also discussed. Data were analysed statistically with appropriate tests.
Results One hundred (n=100) consecutive patients who were advised weekly LD-MTX injections and taught the self-injection technique were enrolled in this study. On follow-up visit it was found that among them 57 patients (n1) learned and started taking the subcutaneous injection of LD-MTX (either by self or by the attendant who had learnt techniques at the clinic) while the other 43 (n2) did not. The various parameters were statistically analysed to find out which one of them were associated with acceptability for learning injection technique and which ones were impeded. Of the various variables studied, the family support was the only factor that proved to be highly significantly (“p” value 0.0001) associated with the acceptance to learn the self-injection technique. No other variable showed any influence on the learning of LD-MTX self-injection.
Conclusions Among all the variable studied only family support showed a strong association (“p” =0.00001) with learning capabilities for the technique of subcutaneous injection of LD-MTX. Therefore, this preliminary study indicates that for the success of this route of self-administration of LD-MTX and making the patient independent, family support needs to be harnessed. This would improve drug efficacy and disease control
Hazlewood et al. The comparative effectiveness of oral versus subcutaneous methotrexate for the treatment of early rheumatoid arthritis. Ann Rheum Dis. May 2015
Malaviya AN, Sharma A, Agarwal D, Kapoor S, Garg S, Sawhney S. Low-dose and high-dose methotrexate are two different drugs in practical terms. Int J Rheum Dis. 2010 Oct
Disclosure of Interest R. Rawat: None declared, S. Baghel: None declared, R. Thakran: None declared, C. Messi: None declared, S. Kapoor Consultant for: Advisory board of IPCA, Janssen., S. Garg Consultant for: Advisory board of Roche and Intas, A. Malaviya Consultant for: Advisory board of IPCA, Janssen, Pfizer, Roche, BMS, Dr. Reddy's., Speakers bureau: dvisory board of IPCA, Janssen, Pfizer, Roche, BMS, Dr. Reddy's.