• Olga Brzezińska, Anita Kuc, Diana Kobiałka, Dawid Małecki, and Joanna Makowska.
• Department of Rheumatology, Medical University of Lodz, Łódź, Poland.
• Int. J. Clin. Pract. 2021 Mar 1; 75 (3): e13677.

IntroductionMethotrexate (MTX) is the first-line medicine used in most inflammatory joint diseases. It is highly effective but, it's burdened with common side effects and the result of treatment is not immediately visible. This fact significantly increases the risk of unsatisfying patients' compliance. It may lead to difficulties in achieving disease remission and unjustified escalation of treatment.PurposeThe aim of the study was to evaluate the methotrexate treatment schemes and to assess the patients' compliance with the treatment.Materials And MethodsThe study was based on an online questionnaire distributed to rheumatic patients treated with MTX. The questions about MTX therapy, treatment monitoring, patients' compliance and causing of skipping drug doses were asked.ResultsThe questionnaire was filled up by 415 patients (21 men, 394 women and average age 36 ± 12.3). In 238 cases the MTX therapy was discontinued, in 148 the decision was taken by the physician, the others discontinued treatment on their own (90 subjects). From the group of patients who stopped taking MTX, 140 returned to the previous treatment. The most common cause of stopping treatment was gastrointestinal (GI) side effects. Self-discontinuation was more often explained by unbearable side-effects (63.33% vs 44.59%; P = .005) such as GI complaints, headaches and bad mood. The doctor's decision to stop treatment was more often caused by the occurrence of liver damage and the improvement of the patient's condition. Good compliance was declared by 346 patients. Most of them (61.69%) admit to skipping MTX doses. The most common reasons for missing a dose were: infectious disease and forgetfulness. The group of patients with good adherence to therapy was significantly older with longer disease duration.ConclusionHigh adherence with prescribed MTX is associated with good treatment tolerance, while the occurrence of side effects significantly increases the risk of discontinuation, often without consulting the physician.© 2020 John Wiley & Sons Ltd.

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