MISS questionnaire in French version: a good tool for children and parents to assess methotrexate intolerance

Abstract

The aim of this study was to assess the relevance for children and parents to use the French-validated version of the methotrexate intolerance severity score (MISS), a measure of methotrexate intolerance for children suffering from juvenile idiopathic arthritis. The French-version MISS was developed following the "Guidelines for the process of cross-cultural adaptation of self-report measures." The new version was tested in families of children with juvenile idiopathic arthritis who completed the questionnaire twice at a 2-week interval. Item correlations, Cronbach's alpha, and kappa coefficients were computed to evaluate acceptability, internal consistency, and reproducibility. A culturally acceptable version to French was obtained. A total of 71 individuals were included from May 2015 to November 2015. The results show very good acceptability: good response rate (80%), few missing data (<1%) and good understanding of parents and children. The inter-item, dimension-item, and inter-dimension correlations were satisfactory (except for "vomiting" items-other items correlation). Cronbach's alpha coefficient was well higher than the usually recommended value of 0.6. The results of validity of internal and external consistencies were satisfactory. We also found good agreement between the test-retest for every family. The empirical discriminative cut-off point of 3 showed a sensitivity of 86% and a specificity of 83%. The MISS questionnaire is quick to complete, easy to use. It can be completed by children or their parents with no significant difference. This validated French-version MISS can help study prevalence and risk factors of methotrexate intolerance, better detect this intolerance, and provide better support for patients on long-term treatment.

Increased methotrexate intolerance in juvenile idiopathic arthritis compared to acute lymphoblastic leukaemia in children

“…This Danish version of the MISS had a high internal consistency in the JIA group, indicating the Danish translation of the MISS was satisfactory and supporting other studies in the MISS being easy to adapt to a new language [15–17]. For the ALL group the analysis of internal consistency questioned whether the behaviour domain fits properly with the remaining MISS.…”

“…Hence, the high proportion of our JIA group receiving low-dose MTX subcutaneously (62.5%) may contribute to the higher proportion of MTX intolerant children with JIA in our study. However, as argued in the study by Patil et al [19] changing the route of administration is a known attempted countermeasure to MTX intolerance [15,16,20,21]. We did indeed see that 64% of the children with JIA treated with subcutaneous low-dose MTX at enrolment had previously received low-dose MTX orally.…”

“…Moreover, if the ALL study population had been larger in size it is plausible that more patients would have had complaints within the behaviour domain. The numeric value of the MISS cut-off score has been debated [6,15]. Hence, when using the MISS it may be more clinically relevant to focus on the ability of the MISS to uncover which aspects of MTX intolerance an individual child is affected by and use the total score for monitoring the patient.…”

High frequency of methotrexate intolerance in longstanding rheumatoid arthritis: using the methotrexate intolerance severity score (MISS)

“…This is currently the only questionnaire that formally evaluates MTX intolerance taking into account the most frequent side effects as well as anticipatory, associative and behavioral symptomswhich are very important in the identification of intolerance. This tool was developed and validated in patients with juvenile idiopathic arthritis [7], and it has also been validated for use in patients with juvenile idiopathic arthritis in the French language [8]. Furthermore, the MISS questionnaire has also been used to determine the prevalence of MTX intolerance in patients with RA and psoriatic arthritis in several countries [4,[7][8][9].…”

“…This tool was developed and validated in patients with juvenile idiopathic arthritis [7], and it has also been validated for use in patients with juvenile idiopathic arthritis in the French language [8]. Furthermore, the MISS questionnaire has also been used to determine the prevalence of MTX intolerance in patients with RA and psoriatic arthritis in several countries [4,[7][8][9]. More recently, the MISS questionnaire has also been validated in Brazilian Portuguese for use in adults with RA [10].…”