Perspectives of patients with rheumatoid arthritis towards the use of parenteral methotrexate: a qualitative study
Bibliographic record
Abstract
INTRODUCTION: Rheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disease. Disease-modifying antirheumatic drugs (DMARDs) are the cornerstone of management and methotrexate is broadly considered as first-line treatment. Gastrointestinal side effects and variable bioavailability however limit adherence to and effectiveness of oral methotrexate, while parenteral methotrexate remains underutilized. AIM: To explore RA patients' perspective and their level of acceptance towards parenteral methotrexate and to investigate the barriers and enablers to its use. METHOD: A qualitative study was conducted using semi-structured interviews between May and August 2022. Participants were recruited using convenience and purposive sampling strategy. The Theoretical Framework of Acceptability (TFA) was used to guide the development of the interview guide and data analysis (directed content analysis). RESULTS: Twenty-five participants (68% female, 76% with experience using parenteral methotrexate) were interviewed. All seven TFA constructs were found to influence participants' acceptance of parenteral methotrexate. High acceptance was related to the TFA constructs "perceived effectiveness", "intervention coherence", "self-efficacy" and "ethicality". Experience with disease improvement and gastrointestinal tolerance with parenteral methotrexate was valued by the participants, and understanding these benefits was linked with high acceptability (perceived effectiveness). Participants reported a high level of confidence in using methotrexate injections and adapting to the injection-taking routine (self-efficacy). The user-friendly design of the methotrexate pre-filled syringe, along with the support from healthcare professionals, served as enablers (intervention coherence and ethicality). Minimal opportunity costs (e.g., no major lifestyle sacrifices) further supported acceptability, though some reported initial injection anxiety (affective attitude). Barriers were frequently identified in the "burden" construct, including travel inconvenience and injection-associated cost. Participants without the experience with methotrexate injections expressed the need for further information, particularly regarding the logistical and safety aspects of parenteral methotrexate (intervention coherence). CONCLUSION: Our findings highlighted that patients' comprehension of the benefits of using parenteral methotrexate, confidence in self-administration, healthcare professionals' support, and the ease of using injections may help optimize treatment acceptability, underscoring the importance of patient's education from healthcare professionals and the availability of patient-friendly devices.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".