THU0729-HPR BENEFITS OF EMPOWERING THE PATIENTS TO SELF-ADMINISTER SUBCUTANEOUS LOW DOSE METHOTREXATE (LD-MTX) INJECTIONS IN PATIENTS WITH SYSTEMIC IMMUNO-INFLAMMATORY RHEUMATIC DISEASES (SIRDS): A STUDY BY RHEUMATOLOGY NURSES COUNSELLOR
Authors: Sadhana Baghel, Ravita Thakran, Christy Messi, Vlinay Yadav, Vivekanand Kashyap, Qamar Zaheer
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> In recent years, early aggressive targeted treatment for SIRDs is recommended. LD-MTX is the "anchor drug" for these diseases. The administration of LD-MTX using subcutaneous route increases its therapeutic efficacy that ensures the maximum bioavailability and reduces gastrointestinal adverse effects. Therefore, it is preferred over the oral route. Increased use of subcutaneous self injection of medication has benefits for the patients and healthcare system. Increased use of subcutaneous self injection could alleviate pressure on medical services by reducing hospital/clinic visits. Therefore, explaining the benefits of self administration of subcutaneous injection such as early disease control, increased drug adherence, positive attitudes towards life, decreased financial burden of administration cost, decreased dependency to the others, should be an imperative part of patient's education. <h3>Objectives</h3> Benefits of self-administered subcutaneous LD-MTX injection in patients with SIRDs. <h3>Methods</h3> This retrospective study included patients who were prescribed injectable LD-MTX for their treatment. Besides the demographic information (age, gender) and disease characteristics (diagnosis, duration, prior treatment), the patients were interviewed and counselled regarding the virtues to take subcutaneous LD-MTX self-injection. The technique for self-injection of LD-MTX subcutaneously was explained and demonstrated to the patients. All the information including the follow-up details, were recorded in a pre-designed form. <h3>Results</h3> Three hundred (n=300) consecutive patients who were advised weekly LD-MTX injections and taught the self-injection technique were enrolled in this study. On follow-up visit it was found that among them, 177 patients (59%) learned and started to administer their own subcutaneous injection of LD-MTX and they adhered to the injection schedule, in 50 (16.7%) patients the injections was being given by the attendant (who had learnt the injection technique because the patients had deformities), while the other 73 (24.3%) were not very compliant to injections due to psychological barriers towards self-injection, worried about pain and incorrect technique, adverse effects of the incorrect injections social stigma related to self-injections, and frustration or lack of acceptance of the illness. <h3>Conclusion</h3> By empowering the patients to self-administer LD-MTX injections subcutaneously, a majority (59%) of them successfully continued to take the medicine appropriately. Thus this study shows the important role the nurses' play in educating patients and helping them to overcome psychological barriers to self injection. Empowering the patients to take self-administer injections would result in better long term treatment adherence, improving treatment flexibility and overall quality of life. <h3>References</h3> [1] Hazlewood, et al. The comparative effectiveness of oral versus subcutaneous methotrexate for the treatment of early rheumatoid arthritis. Ann Rheum Dis. May 2015 [2] Malaviya AN, Sharma A, Agarwal D, Kapoor S, Garg S, Sawhney S. Low-dose and high-dose methotrexate are two different drugs in practical terms. Int J Rheum Dis. 2010 Oct <h3>Acknowledgement</h3> The authors gratefully acknowledge the help and encouragement from Prof A. N. Malaviya HOD, Drs. Sanjiv Kapoor, SR Garg (Sr. Consultant Rheumatologists at ISIC. We also wish to thank Dr. Parth Sharma (Junior Resident), Mr. Himanshu Negi (Data Entry) <h3>Disclosure of Interests</h3> None declared