TARGETED INFORMATION ON METHOTREXATE AND LIFTING ALCOHOL RESTRICTIONS IN PATIENTS WITH RA AND PSA IS SAFE AND REDUCES PATIENTS' NEGATIVE BELIEFS

Background Research regarding potential interaction between use of Methotrexate (MTX) and alcohol consumption is sparse (1-2, 5). Nevertheless patients traditionally are advised against alcohol intake while on MTX for safety reasons. Furthermore MTX generally is perceived by doctors and patients as a cytotoxic agent. Thus patients often associate the drug to cancer treatment and thereby resent the treatment. However, the doses used in the treatment of arthritis of <= 25 mg weekly only exerts anti-inflammatory effects. Recently the British society of Rheumatology has lifted their restrictions on alcohol intake (3) and one study found no evidence of increased liver toxicity accordingly (4). We present the results of a prospective single centre questionnaire study with one year follow up on the effects of an altered information strategy stressing the anti-inflammatory effects of MTX and lifting alcohol restrictions asking patients to adhere to national Danish guidelines (5). Objectives To investigate the effects of altered information strategy and the safety of increased alcohol limits for patients with Rheumatoid Arthritis and Psoriatic Arthritis. Methods Patients in a single outpatient clinic receiving MTX for Rheumatoid Arthritis or Psoriatic Arthritis were interviewed by postal delivered questionnaire for their beliefs regarding MTX and their alcohol consumption (6). Informed consent was obtained. The patients were on stable treatment for at least 6 months prior to answering the questionnaire. Liver enzyme levels the preceding year were gathered. A new information leaflet stressing the anti-inflammatory effects of MTX and advising alcohol intake kept within national guidelines was sent to all responders. One year later a follow up questionnaire was sent and liver enzyme levels during the year of observation was collected. All data were entered into a database and analyzed with descriptive and non-parametric statistical analyses. Results 117/127 patients responded to the one year follow up questionnaire. 76% were women, and 24% men. 10 patients were lost to follow up due to various reasons. 105 patients were still on MTX while 12 had discontinued their treatment for reasons of lack of response, side effects or planned pregnancies. Average dose of MTX was 14.7 mg/14.3 mg weekly. Alcohol was used by 97.7% compared to 79.2% at baseline. 10.5 % of the patients indicated that they had increased their intake of alcohol after receiving the new guideline. The mean consumption increased from 3.7 units to 5.5 units weekly (p=0.002). 13 % occasionally exceeded the limit. 10 % of the patients had significantly elevated liver enzymes (2xULN) prior to the intervention, and 9.5 % a year after (p = 0.98). Only 22% of the patients felt bothered by alcohol restrictions compared to 47% at baseline (p= 0.01). 19 % of the patients developed a more positive view on MTX treatment. Conclusions Written information stressing the anti-inflammatory effects of MTX leads to a more positive attitude towards the treatment, which in turn may lead to reduction in perceived side effects. Allowing patients to adhere to national Danish guidelines on weekly consumption of alcohol lead to an increase in weekly intake but did not increase liver toxicity.