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Analysis of methotrexate monitoring practices during treatment of juvenile idiopathic arthritis according to centre size
  1. D Hawley,
  2. S Rangaraj,
  3. L Hutchinson,
  4. N Camina,
  5. H Venning
  1. Paediatric Rheumatology, Nottingham Children's Hospital, Nottingham, UK


Aims Methotrexate is currently accepted as the first line disease modifying antirheumatic drug for juvenile idiopathic arthritis. Regular blood test monitoring for early signs of hepatotoxicity and bone marrow suppression is necessary. National guidelines for blood test monitoring exist; however, there is a paucity of underpinning evidence and anecdotal evidence suggests varying practice in this area. Children in the British Isles are managed in paediatric rheumatology networks, with relatively few tertiary units. The authors aimed to survey current paediatric rheumatology blood test monitoring practice across the British Isles in all contexts where this occurs.

Methods The authors used a web-based tool to survey all members of the British Society for Paediatric and Adolescent Rheumatology. The authors asked respondents about their centre, number of children treated, guidelines, blood test monitoring (including changes to frequency during periods of stability) and approach to abnormal blood test results. The authors encouraged a single team response from each centre.

Results Responses were received representing 33 centres across England, Wales, Scotland and Ireland. The authors divided responses received into “large centres” (treating >100 children) and “small centres” (treating <100 children). Variation existed between large and small centres in all aspects of methotrexate blood monitoring surveyed (see table 1).

Abstract G69 Table 1

Conclusions The results of the survey showed variation in monitoring practice among UK practitioners, mirroring a survey of North American practice. We discuss possible reasons for a more cautious approach adopted by small centres. We propose closer networking of centres providing paediatric rheumatology services to ensure standardisation of care pathways.

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