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. 2023 Jan 31;12(3):1116.
doi: 10.3390/jcm12031116.

Cross-Cultural Adaptation and Validation of the Methotrexate Intolerance Severity Score Questionnaire in Portuguese (Brazil) for Children and Adolescents with Juvenile Idiopathic Arthritis

Ana Carolina Londe  1 , Jaqueline Cristina de Amorim  2 , Paulo Rogério Julio  2 , Nico M Wulffraat  3 , Roberto Marini  4 , Simone Appenzeller  5
Affiliations

Cross-Cultural Adaptation and Validation of the Methotrexate Intolerance Severity Score Questionnaire in Portuguese (Brazil) for Children and Adolescents with Juvenile Idiopathic Arthritis

Ana Carolina Londe et al. J Clin Med. .

Abstract

The Methotrexate (MTX) Intolerance Severity Score (MISS) questionnaire has been developed to identify MTX adverse events in juvenile idiopathic arthritis (JIA). The objective of this study was to translate and validate MISS into Brazilian Portuguese for children and adolescents. The MISS was translated into Portuguese following the standardized guidelines. We analyzed the following psychometric properties: acceptability, internal consistency, test-retest reproducibility, relative-child reliability, and external criterion and discriminant validity. We included 138 JIA patients (age: 8-18 years) and 108 relatives who took less than 5 min to answer MISS. Reproducibility tested after 15 days was good, with a kappa > 0.76. We observed good internal consistency (Cronbach's coefficient 0.75-0.87 (patients) and 0.75-0.79 (relatives)). Reliability between patients and relatives was good except for stomachache and restlessness. Cut-off points of 5 and 6 had good sensitivity (84 and 71, respectively) and specificity (80 and 87, respectively). Using a cut-off value of 6, we observed 86 (62.3%) MTX-intolerant patients. In conclusion, MISS is a viable and practical tool for routine clinical care to identify MTX intolerance in JIA. Parents do not easily identify stomachache and restlessness as adverse MTX events.

Keywords: intolerance; juvenile idiopathic arthritis; methotrexate; questionnaire validation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
ROC curve plotting MTX intolerance with the questionnaire against the gold standard with cut-off scores of 5, including JIA and relative responses. AUC = 0.90 (95% CI, 0.85–0.94).
Figure 2
Figure 2
ROC curve plotting MTX intolerance with the questionnaire against the gold standard with cut-off score of 5 in JIA patients. AUC = 0.89 (95% CI, 0.80–0.95).
Figure 3
Figure 3
Principal component analysis of the translated MISS score.
Figure 4
Figure 4
Distribution of total MISS scores in JIA patients. The MISS score was from 0 to 36 points.
See this image and copyright information in PMC

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