Role of Ondansetron in Reducing Methotrexate Intolerance in Patients with Inflammatory Arthritis.

OBJECTIVE: To determine the frequency of intolerance to Methotrexate (MTX) in patients with inflammatory arthritis by using MTX intolerance severity score, and evaluate the effects of Ondansetron in reducing MTX intolerance. STUDY DESIGN: Interventional study. PLACE AND DURATION OF STUDY: Rheumatology clinic, Combined Military Hospital (CMH), Lahore, from 1st November 2021 to 30th April 2022. METHODOLOGY: Patients with inflammatory arthritis taking methotrexate regularly for >3 months participated in the study. The patients' age, gender, education level, marital status and smoking history were documented. The disease duration and disease activity was also recorded. Dose/duration/route/frequency and timing of MTX were noted. MTX intolerance was calculated with the use of the Methotrexate intolerance severity score (MISS) questionnaire. Those MTX intolerant patients who reported nausea and vomiting were prescribed ondansetron along with MTX and were followed up for the next 3 consecutive months. RESULTS: Out of 181 patients, 48(26.5%) showed methotrexate intolerance. The predominant symptom was nausea after taking MTX reported in 93.8% of the MTX intolerant patients followed by behavioural symptoms including restlessness and irritability reported among 79% and 77% of intolerant patients respectively. Those methotrexate intolerant patients who mainly had complaints of nausea and vomiting were started on ondansetron on the day of methotrexate and showed a significant reduction in the median of MISS score in the following two consecutive months (p <0.05) while at 3 months the median did not show further reduction as compared to second month (p=0.12). CONCLUSION: Ondansetron prescribed along with methotrexate in patients having complaints of nausea and vomiting with MTX, reduces the intolerance significantly. KEY WORDS: Rheumatoid arthritis, Methotrexate, Ondansetron, Nausea, Arthritis juvenile.

Quality Of Sleep And Its Associated Factors Among Diabetics And Non Diabetics.

BACKGROUND: Diabetes mellitus is the metabolic state which has shown a persistent global rise in numbers. It is therefore necessary to closely assess all aspects of this state. Sleep quality and diabetic control have a relation where both can affect each other. Therefore, we aim to study the quality of sleep and factors affecting it in our diabetic population. The objective of the study was the identification of quality of sleep and factors affecting it in the diabetic and non diabetic adult population. METHODS: In this comparative cross sectional study quality of sleep was evaluated in all the patients through the Pittsburgh Sleep Quality Index. Statistical analysis was conducted with the SPSS-23. RESULTS: The total number of study participants were 250 adults (18 years and above), where 125 were diabetics, while 125 were non diabetics. In Diabetic group, the total number of patients with impaired sleep was 65 (52%). In non-diabetic group, impaired sleep was found in 70 (56%) individuals. The mean age of diabetics was 55.2±11.6 years and non-diabetics was 37.23±12.017 years. Prevalence of restless leg syndrome and depression among diabetics was 33 (26.4%) and 30 (24.0%) respectively and in nondiabetic was 20 (16.0%) and 63 (50.4%). Impaired sleep quality was associated with the use of cell phones before going to bed (p-value: 0.01) and watching television until late at night in both groups. Impaired sleep is seen more commonly in uncontrolled DM (RR:1.462 and CI: 0.531 to 4.025). CONCLUSIONS: Impaired sleep and uncontrolled DM has a direct relation and the prevalence of Restless leg syndrome (RLS) is higher in Diabetics. Addressing the factors impairing sleep can improve sleep quality and have beneficial effects on the sufferers from this metabolic state.