Methotrexate patient education: a quality improvement study

Arthritis Care Res. 1996 Jun;9(3):216-22. doi: 10.1002/1529-0131(199606)9:3<216::aid-anr1790090310>;2-5.


Objective: To determine patients' knowledge of the safe use and toxicity of methotrexate (MTX) and to define educational interventions implemented by a rheumatology nurse that improved patients' understanding of MTX therapy.

Methods: One hundred eighty-three patients from a university-based rheumatology clinic who were taking MTX completed an initial knowledge questionnaire concerning the proper use and possible toxicity of MTX. Following completion, a nurse reviewed the correct answers with each patient and provided written information on MTX. One hundred thirty-eight of these patients completed a followup questionnaire at the next visit or by mail. The questionnaires were analyzed, and a total MTX knowledge score was calculated.

Results: MTX knowledge improved significantly between questionnaires; mean total score (+/- SD) increased from 7.32 +/- 3.99 to 10.23 +/- 3.29 (P < 0.001). After accounting for a person's initial questionnaire score, the addition of a supplemental "MTX pocket-card" was associated with a higher score on the follow-up questionnaire (adjusted odds ration [OR] = 2.37; 95% confidence interval [CI] 1.14, 4.95; P = 0.021). Patients over age 55 were 4 times more likely to have a poorer score compared with patients under age 45 (adjusted OR = 0.23; 95% CI 0.07, 0.73; P = 0.013).

Conclusion: Knowledge of the toxicity and safe use of MTX was significantly improved by a patient education program utilizing a rheumatology nurse. Older individuals appear to be at higher risk for knowledge deficits. A supplemental MTX pocket-card proved to be a simple but beneficial addition to our MTX educational program.

MeSH terms

  • Aged
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / drug therapy*
  • Arthritis, Rheumatoid / nursing
  • Educational Measurement
  • Female
  • Humans
  • Male
  • Methotrexate / therapeutic use*
  • Middle Aged
  • Multivariate Analysis
  • Nurse Clinicians
  • Patient Education as Topic / organization & administration*
  • Surveys and Questionnaires
  • Total Quality Management*


  • Antirheumatic Agents
  • Methotrexate