Do impaired memory, cognitive dysfunction and distress play a role in methotrexate-related neutropenia in rheumatoid arthritis patients? A comparative study
Do impaired memory, cognitive dysfunction and distress play a role in methotrexate-related neutropenia in rheumatoid arthritis patients? A comparative study
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DOI：
10.1007/s00296-013-2792-2
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发表时间：
2013-10-01
影响因子：
4
通讯作者：
Keystone, Edward C.
中科院分区：
文献类型：
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作者：
Pamuk, Omer Nuri;Kisacik, Bunyamin;Keystone, Edward C.
我们评估了社会文化地位、痛苦和认知功能在类风湿关节炎（RA）患者发生甲氨蝶呤（MTX）相关中性粒细胞减少症中的作用。对3个中心随访的37例伴有mtx相关中性粒细胞减少的RA患者的数据进行评估。对照组包括74例RA患者。从医院档案中获取患者的临床特征、生化检查和治疗方式。对所有伴有中性粒细胞减少的RA患者和对照组进行最小精神状态检查（MMSE）和医院焦虑抑郁量表（HADS）。男性患者、文盲患者、独居患者、严重视力障碍患者、低收入患者、高肌酐患者在RA mtx相关中性粒细胞减少患者中的出现频率显著高于对照组（p值< 0.05）。RA合并mtx相关中性粒细胞减少患者MMSE评分显著低于对照组，HADS-A、HADS-D评分显著高于对照组（p值< 0.05）。此外，伴有mtx相关中性粒细胞减少的RA患者中可能发生痴呆的患者比例显著高于对照组（p < 0.001）。37例患者中有26例（70.3%）在每日给药后出现中性粒细胞减少症。每天服用甲氨蝶呤的患者比每周服用甲氨蝶呤的患者更有可能独自生活（p = 0.011）。多因素分析显示，MMSE测试中可能出现痴呆（OR 52.6）、低收入水平（OR 56.8）和年龄（OR 1.12）是mtx相关中性粒细胞减少症发生的独立危险因素。在使用MTX的RA患者中，MMSE中可能存在痴呆、社会经济地位低和年龄较大与严重毒性有关。应采取措施防止患者误给甲氨蝶呤。依从性和患者教育是非常重要的，特别是在本研究中提出的患者。
We evaluated the roles of sociocultural status, distress and cognitive functions in rheumatoid arthritis (RA) patients who developed methotrexate (MTX)-related neutropenia. The data of 37 RA patients with MTX-related neutropenia who were being followed up at 3 centers were evaluated. The control group included 74 RA patients. The clinical features, biochemical tests and treatment modalities of the patients were obtained from hospital files. The mini-mental state examination (MMSE) test and the Hospital Anxiety and Depression Scale (HADS) were administered for all RA patients with neutropenia as well as the control group. The frequencies of male patients, illiterate patients, patients living alone, patients with serious visual impairment, those with low income, and patients with high creatinine were significantly higher among RA patients with MTX-related neutropenia than in controls (p values < 0.05). The RA patients with MTX-related neutropenia had significantly lower MMSE scores, and significantly higher HADS-A and HADS-D scores than controls (p values < 0.05). In addition, the proportion of patients with probable dementia was significantly higher in RA patients with MTX-related neutropenia than in controls (p < 0.001). Twenty-six of the 37 patients (70.3 %) developed neutropenia with daily dosing. Patients who used MTX daily were more likely to be living alone than those using weekly dosing (p = 0.011). Multivariate analysis showed that having probable dementia on the MMSE test (OR 52.6), low income level (OR 56.8) and age (OR 1.12) were independent risk factors for the development of MTX-related neutropenia. The presence of probable dementia on MMSE, low socioeconomical status and older age are associated with serious toxicity in RA patients using MTX. Measures should be taken to prevent wrong MTX dosing by the patients. Compliance and patient education is of major importance, in particular, in the patients presented in this study.