The role of liver transaminase levels in methotrexate intolerance in juvenile idiopathic arthritis-a cross-sectional study

被引：1
作者：
Wibrand, Camilla [1 ]
Kyvsgaard, Nini [2 ]
Christensen, Anne Estmann [3 ]
Herlin, Troels [1 ]
机构：
[1] Aarhus Univ Hosp, Pediat & Adolescent Med, Aarhus, Denmark
[2] Godstrup Hosp, Pediat & Adolescent Med, Godstrup, Denmark
[3] Odense Univ Hosp, Pediat & Adolescent Med, Odense, Denmark
来源：
RHEUMATOLOGY INTERNATIONAL | 2023年 / 43卷 / 5期
关键词：
Juvenile idiopathic arthritis; Liver transaminases; Methotrexate; Methotrexate intolerance; Methotrexate intolerance severity score; RHEUMATOID-ARTHRITIS; VALIDATION; TOXICITY; CHILDREN; INJURY;
D O I：
10.1007/s00296-023-05297-3
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
Methotrexate (MTX) plays a key role when treating juvenile idiopathic arthritis (JIA), but MTX-intolerance is challenging. MTX-treatment might affect the liver, causing elevated levels of alanine aminotransferase (ALT), yet the role of ALT-levels in MTX-intolerance in JIA remains unclear. Our study aimed to investigate the association between ALT-levels during MTX-treatment and MTX-intolerance in JIA. Children (> 9 years old) diagnosed with JIA and treated with MTX (> 6 weeks) were eligible for enrollment. MTX-intolerance was assessed using the Methotrexate Intolerance Severity Score (MISS), completed by the parents, and defined as MISS >= 6 with at least 1 point for a behavioral/anticipatory/associative symptom. ALT-levels were determined at enrollment. A total of 118 children were enrolled (80 girls; 38 boys). MTX-intolerance was registered in 61%. ALT-levels did not differ between the MTX-intolerant group (median = 17.0 U/L [IQR: 14.0-26.0]) and the MTX-tolerant group (median = 20.5 U/L [IQR: 16.0-27.5]; p = 0.17). MTX-intolerance was prevalent in around 60% of both boys and girls. Nine out of 50 MTX-intolerant girls had elevated ALT-levels compared to 0/22 MTX-intolerant boys, however, there was no difference in median ALT levels between the two groups. Furthermore, the MTX-intolerant girls had a higher MISS (median = 14.0 [IQR: 9.3-17]) than the MTX-intolerant boys (median = 10.0 [IQR: 7.3-12]; p = 0.009). Our study did not find a difference in ALT-levels between MTX-intolerant and MTX-tolerant children. However, only MTX-intolerant girls and no MTX-intolerant boys showed elevated ALT-levels.
引用
收藏
页码：875 / 880
页数：6
相关论文
共 19 条
[1]   Risk Factors Associated with Methotrexate Intolerance in Rheumatoid Arthritis Patients [J].
Almalag, Haya ;
Abouzaid, Hanan H. ;
Alnaim, Lamya ;
Albaqami, Jawza ;
AlShalhoub, Rawan ;
Almaghlouth, Ibrahim ;
Dessougi, Maha ;
Al Harthi, Amal ;
Bedaiwi, Mohamed ;
Alfi, Eman ;
Omair, Mohammed .
OPEN ACCESS RHEUMATOLOGY-RESEARCH AND REVIEWS, 2020, 12 :193-202
[2]  
Berntson L, 2003, J RHEUMATOL, V30, P2275
[3]   Gastrointestinal symptoms and their association with health-related quality of life of children with juvenile rheumatoid arthritis - Validation of a gastrointestinal symptom questionnaire [J].
Brunner, HI ;
Johnson, AL ;
Barron, AC ;
Passo, MH ;
Griffin, TA ;
Graham, TB ;
Lovell, DJ .
JCR-JOURNAL OF CLINICAL RHEUMATOLOGY, 2005, 11 (04) :194-204
[4]   High Prevalence of Methotrexate Intolerance in Juvenile Idiopathic Arthritis Development and Validation of a Methotrexate Intolerance Severity Score [J].
Bulatovic, Maja ;
Heijstek, Marloes W. ;
Verkaaik, Marleen ;
van Dijkhuizen, E. H. Pieter ;
Armbrust, Wineke ;
Hoppenreijs, Esther P. A. ;
Kamphuis, Sylvia ;
Kuis, Wietse ;
Egberts, Toine C. G. ;
Sinnema, Gerben ;
Rademaker, Carin M. A. ;
Wulffraatl, Nico M. .
ARTHRITIS AND RHEUMATISM, 2011, 63 (07) :2007-2013
[5]   Methotrexate polyglutamates in erythrocytes are associated with lower disease activity in juvenile idiopathic arthritis patients [J].
Calasan, Maja Bulatovic ;
den Boer, Ethan ;
de Rotte, Maurits C. F. J. ;
Vastert, Sebastiaan J. ;
Kamphuis, Sylvia ;
de Jonge, Robert ;
Wulffraat, Nico M. .
ANNALS OF THE RHEUMATIC DISEASES, 2015, 74 (02) :402-407
[6]   Age and Sex Specific Trends in Incidence of Juvenile Idiopathic Arthritis in Danish Birth Cohorts from 1992 to 2002: A Nationwide Register Linkage Study [J].
Cardoso, Isabel ;
Frederiksen, Peder ;
Specht, Ina Olmer ;
Handel, Mina Nicole ;
Thorsteinsdottir, Fanney ;
Heitmann, Berit Lilienthal ;
Kristensen, Lars Erik .
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, 2021, 18 (16)
[7]   Methotrexate in juvenile idiopathic arthritis: advice and recommendations from the MARAJIA expert consensus meeting [J].
Ferrara, Giovanna ;
Mastrangelo, Greta ;
Barone, Patrizia ;
La Torre, Francesco ;
Martino, Silvana ;
Pappagallo, Giovanni ;
Ravelli, Angelo ;
Taddio, Andrea ;
Zulian, Francesco ;
Cimaz, Rolando .
PEDIATRIC RHEUMATOLOGY, 2018, 16
[8]   MTX intolerance in children and adolescents with juvenile idiopathic arthritis [J].
Huegle, Boris ;
van Dijkhuizen, E. H. Pieter .
RHEUMATOLOGY, 2020, 59 (07) :1482-1488
[9]   Monitoring Methotrexate Toxicity in Juvenile Idiopathic Arthritis [J].
Kocharla, Lakshmi ;
Taylor, Janalee ;
Weiler, Tracey ;
Ting, Tracy V. ;
Luggen, Michael ;
Brunner, Hermine I. .
JOURNAL OF RHEUMATOLOGY, 2009, 36 (12) :2813-2818
[10]   Single nucleotide polymorphisms associated with methotrexate-induced nausea in juvenile idiopathic arthritis [J].
Kyvsgaard, Nini ;
Mikkelsen, Torben Stamm ;
Als, Thomas D. ;
Christensen, Anne Estmann ;
Corydon, Thomas J. ;
Herlin, Troels .
PEDIATRIC RHEUMATOLOGY, 2021, 19 (01)
12