Method: Twentyfive RA patients (14 females, 11 males) who were being followed up at 2 centers and who developed pancytopenia and/or febrile neutropenia were included into the study. The control group included 3 RA patients whose hospital registration numbers were immediately after the RA patient of interest (72 cases; 61 females, 11 males). Patients’ baseline clinical and sociodemographic features were recorded down from hospital files. RA patients who developed methotrexate toxicity were administered the mini mental test (MMT) and hospital anxiety and depression scale (HADS) one month after discharge from hospital. The controls were also administered the above-mentioned tests
Result: Three of the patients (12%) with MTX toxicity died. Eight patients (32%) had concurrent hepatotoxicity, the ALT levels were 2-3 times higher than normal only in 2 patients. RA patients with MTX-related pancytopenia were more frequently males (56% vs. 15.3%, p<0.001), did not know how to read and write (52.4% vs. 16.2%, p=0.004), were more frequently living alone /24% vs. 7%, p=0.03), and higher creatinine levels (1.22+0.7 vs. 1.02+0.8, p=0.035) when compared to controls. The groups were similar in age, RF, anti-CCP positivity, HAQ scores, and annual income (all p values >0.05). When the questionnaires were interpreted, it was seen that MMT scores were significantly lower in the MTX toxicity group (22.6±4.3 vs. 26.08±4.8, p=0.002); HADS-A (10.4±4.7 vs. 7.5±3.8, p=0.016) and HADS-D (10.5±4.5 vs. 5.5±4.2, p=0.001scores were significantly higher.
Conclusion: The risk factors for the development of MTX-related pancytopenia in our study were male sex, high creatinine levels, having a low educational level, living alone and visual impairment. In addition, we observed that the presence of impaired memory, depression and anxiety played important roles for the development of methotrexate toxicity. As a result, we conclude that the administration of the MMT to RA patients with low education level, living alone and who are planning to be given MTX, might prove useful to decrease toxicity.
Disclosure: S. Donmez, None; Y. Pehlivan, None; O. N. Pamuk, None; B. Kisacik, None; G. E. Pamuk, None; A. M. Onat, None; M. Sayarlioglu, None; G. Y. Çetin, None.