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Mothers’ reports of the difficulties that their children experience in taking methotrexate for Juvenile Idiopathic Arthritis and how these impact on quality of life

Kathleen Mulligan13, Laura Kassoumeri2, Angela Etheridge2, Halima Moncrieffe2, Lucy R Wedderburn2 and Stanton Newman1*

Author Affiliations

1 School of Health Sciences, City University London, Northampton Square, London, EC1V OHB, UK

2 Rheumatology Unit, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK

3 East London NHS Foundation Trust, EastONE, 22 Commercial Street, London, E1 6LP, UK

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Pediatric Rheumatology 2013, 11:23  doi:10.1186/1546-0096-11-23

Published: 28 May 2013



Children who take methotrexate for juvenile idiopathic arthritis may experience side effects, including nausea and vomiting, leading to anticipatory nausea in some children, and fear of injections or blood tests. The aim of this study was to examine the prevalence and extent of these difficulties and their impact on quality of life.


Participants were mothers of children with JIA who were currently taking methotrexate (MTX). Mothers completed a questionnaire about MTX that was developed for the study, two questions from the treatment subscale of the Pediatric Quality of Life Inventory (PedsQL) Rheumatology scale to assess needle-related problems and the Child Health Questionnaire 50-item parent version (CHQ-PF50) to assess health-related quality of life (HRQoL).


171 mothers participated in the study. More than half of children were reported to have experienced one or more of: nausea or vomiting after taking MTX, anticipatory nausea, fear of blood tests or fear of injections. There was no significant difference in reported rates of sickness or needle-related problems between MTX responders (ACR70 or above), partial responders (ACR30 or ACR50) and non-responders. In multivariate analyses, variables that were significant independent predictors of one or more MTX-related difficulties included younger age, taking MTX subcutaneously and having a larger number of currently active joints. Feeling sick after taking MTX was a significant independent predictor of poorer scores on the physical summary scale of the CHQ-PF50. Anxiety about injections and feeling sick after taking MTX were significant independent predictors of poorer scores on the psychosocial summary scale.


Difficulties in taking MTX are experienced by a significant proportion of children with JIA and these may have an adverse impact on HRQoL. Approaches to help minimize these difficulties are required.

Juvenile idiopathic arthritis; Methotrexate; Side effects; Intolerance; Anticipatory nausea; Psychological; Quality of life