1279 - Do Impared Memory, Cognitive Dysfonction and Distress Play a Role In Methotrexate-Related Pancytopenia In Rheumatoid Arthritis Patients?

Monday, November 7, 2011: 9:00 AM-6:00 PM
Hall F2 - Poster Hall (McCormick Place West)
Salim Donmez1, Yavuz Pehlivan2, Omer Nuri Pamuk1, Bunyamin Kisacik2, Gulsum Emel Pamuk1, Ahmet Mesut Onat2, Mehmet Sayarlioglu3 and Gözde Yildirim Çetin3, 1Edirne, Turkey, 2Gaziantep, Turkey, 3Kahramanmaras, Turkey
Presentation Number: 1279

Background/Purpose: Studies which investigate the risk factors for methotrexate (MTX)-related pancytopenia in rheumatoid arthritis (RA) patients conclude that the most important factors are age, the dose of methotrexate and genetic factors. In this study, we investigated the role of impaired memory and distress on the development of methotrexate-related hematological toxicity

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.


Keywords: cognitive dysfunction, methotrexate (MTX) and rheumatoid arthritis (RA)

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.