Adherence by patients on Methotrexate to getting the advised regular laboratory tests done


Salamet Ali, Arslan Ather, Ursula Bond, Eleanor Dunlee, Michael Regan


South Infirmary Victoria University Hospital, Cork


Arthritis still remains the biggest cause of disability and major cost on healthcare system. In Ireland 18% of population under age of 55. Three quarters of patients are in working age. Methotrexate is used as the anchor drug in the treatment of Inflammatory Arthritis. Methotrexate causes bone marrow suppression, liver parenchymal toxicity and renal toxicity. Therefore, all patients who are put on Methotrexate are advised by Consultant /team NCHD at each visit to clinic that they need regular monitoring with laboratory tests at designated intervals. They also receive education about Methotrexate and importance of monitoring labs by Rheumatology Specialist Nurse.


To determine the level of compliance with blood monitoring as advised at the clinic visit when MTX was first started, as well as is advised at all subsequent visits to clinic, in accordance with ACR/BSR guidelines & local protocols, in order to detect abnormalities early on and thus prevent adverse affects of MTX on the liver, kidney and bone marrow.


Data was collected from 50 consecutive patients at follow-up visits at Rheumatology clinics in South Infirmary-Victoria University Hospital over a 3-month period from 1st October 2018 to 31st December 2018. After consent, the patient was interviewed & a questionnaire was filled for data collection taken together with evidence of such lab monitoring from the i-lab system and blood reports gotten from their GP.


Data was collected from 50 consecutive patients: 44 patients (88%) were compliant with the advised laboratory monitoring regularity as was clearly advised to them at their clinic visits & clinic letter sent to their GP. Out of 50, only 6 patients (12%) were non-compliant with laboratory monitoring.


The audit shows that the vast majority of patients on Methotrexate (88%) are fully compliant with laboratory monitoring while only 12% are not. We can now look at how can we increase this percentage in order to try and get it as near as possible to 100%.