AB0913-PARE METHOTREXATE FOR RHEUMATOID ARTHRITIS: PATIENT PERSPECTIVES ON MONITORING IN PRIMARY CARE

Background: Monotherapy with methotrexate (MTX) is one first-line option for newly diagnosed Rheumatoid Arthritis (RA)1. Although treatment is usually commenced by a specialist, repeat prescribing and monitoring responsibilities often lie with primary care. While inadequate monitoring is a safety concern, unnecessary duplication of monitoring invariably has cost implications for General Practice (GP). Objectives: To ensure that patients in one South-West GP practice who are taking oral MTX for RA are appropriately monitored in line with current guidance from the British Society of Rheumatology (BSR). Current guidance recommends that once a stable MTX dose is maintained for six weeks, followed by monthly bloods for the next three months, that at least twelve weekly blood monitoring is sufficient from then on1. Methods: A randomised sample of 50 patients registered in one South-West GP practice that were taking a stable dose oral MTX for RA; for at least 6 months; was collected. The length of time between the patient’s two most recent blood tests was recorded. A random selection of ten patients with more frequent monitoring than BSR guidance suggest were asked a series of questions to determine patient perspectives on reasons for monitoring frequency. Results: 58% of patients had more frequent monitoring bloods than current BSR guidelines recommend. Within this group, the mode frequency of monitoring was four weeks, in line with the previous National guidance which was superseded in 20172.The most common themes in patient’s perspectives on monitoring frequency were: a.Previous abnormal blood results requiring close monitoring b.Multiple disease modifying anti-rheumatoid drug (DMARD) regimes that included MTX c.Patient preference d.Unclear or unknown reason The purported increased monitoring for multiple DMARD regimes were not in line with current national guidelines1. Conclusion: This audit demonstrates that over half of patients taking MTX for RA in one GP practice are having more frequent blood monitoring than BSR guidance suggests is necessary. Furthermore, it demonstrates that patient’s understanding of their perceived need for increased monitoring is largely inaccurate or unclear to them. There is a clear deficit in patient education surrounding monitoring frequency which must be addressed in order to empower patients, as well as reducing unnecessary duplication of blood tests. As a result of this audit, patient education on MTX monitoring frequency was formally introduced as part of the RA annual patient review. An information sheet with these monitoring requirements was produced to aid practitioners in the education process. References: [1]J, Ledingham et al | BSR/ BHPR guideline for the prescription and monitoring of non-biologic disease-modifying anti-rheumatic drugs | Rheumatology 2017; 56: 865-8. [2]Chakravarty K etc al | BSR/BHPR guideline for disease-modifying anti-rheumatic drug (DMARD) therapy in consultation with the British Association of Dermatologists | Rheumatology 2008; 47: 924–5. Disclosure of Interests: None declared