Assessment of methotrexate intolerance through methotrexate intolerance severity score (MISS questionnaire) patients of Rheumatoid Arthritis.


  • Muhammad Ammad Asghar Sahiwal Medical College, Sahiwal.
  • Masooma Hashmat Mayo Hospital, Lahore.
  • Abrar Ahmed Wagan Indus Medical College, Tando Muhammad Khan.
  • Zafar Ali Zafar Independent University Hospital, Faisalabad.
  • Atta-ur-Rehman Faisalabad Medical University, Faisalabad.
  • Ali Rukh Pirzada BVH, Bahawalpur.



Abdominal Pain, Intolerance, Irritability, Methotrexate, Nausea, Rheumatoid Arthritis, Refusal


Objective: To assess the frequency of methotrexate intolerance in patients with rheumatoid arthritis by using methotrexate intolerance severity scale. Study Design: Cross Sectional study. Setting: DHQ Teaching Hospital Sahiwal. Period: November 2021 – April 2022. Material & Methods: Sample of 178 cases were selected through non-probability consecutive sampling. Patients of age 20-80 years, either gender, diagnosed with rheumatoid arthritis were enrolled. The MISS questionnaire was used to note the information and in tolerance was noted. Data analysis was done in SPSS version 25.0. Results: In this study, the mean age of patients was 35.12 ± 11.16 years. Out of 178 patients, 24 (13.5%) were males and 154 (86.5%) were females. The mean duration of disease was 31.22 ± 23.94 months. Mean duration of using methotrexate was 12.03 ± 12.61 months. About 33.7% patients had mild to moderate complaint of abdominal pain after taking methotrexate, abdominal pain anticipatory was absent in 98.9% patients and abdominal pain associative was also absent in 96.6% cases. Restlessness was mild in 20 (11.2%) cases, moderate in 22 (12.4%) and severe in 4 (2.2%) cases. Irritability was mild in 22 (12.4%) cases, moderate in 20 (11.2%) and severe in 4 (2.2%) cases. Overall refusal of methotrexate was noted in 38 (21.3%) cases. The mean MISS score attained by patients was 2.93 ± 3.82. Out of 178 patients, 44 (24.7%) had intolerance against methotrexate use for rheumatoid arthritis. Conclusion: The frequency of intolerance against methotrexate in patients of rheumatoid arthritis is high and cannot be ignored. Further trials should be done at adjust dose and alterations must be done to improve the tolerance and outcome of treatment.

Author Biographies

Muhammad Ammad Asghar, Sahiwal Medical College, Sahiwal.

MBBS, FCPS (Med), FCPS,  Medicine, 

Masooma Hashmat, Mayo Hospital, Lahore.

MBBS, FCPS (Med), FCPS (Rheumatology), Senior Registrar Medicine, 

Abrar Ahmed Wagan, Indus Medical College, Tando Muhammad Khan.

MBBS, FCPS (Med), FCPS (Rheumatology), Associate Professor Rheumatology, 

Zafar Ali Zafar, Independent University Hospital, Faisalabad.

MBBS, FCPS, (Med), FCPS (Rheumatology), Assistant Professor Medicine, 

Atta-ur-Rehman, Faisalabad Medical University, Faisalabad.

MBBS, FCPS (Med), FCPS (Rheumatology), Senior Registrar , 

Ali Rukh Pirzada, BVH, Bahawalpur.

MBBS, FCPS (Med), FCPS (Rheumatology), Assistant Professor Medicine,