Chest
Clinical Investigations: DrugsPulmonary Function in Patients Receiving Long-term Low-dose Methotrexate
Section snippets
Population Studied
We prospectively studied each patient who was beginning low-dose weekly MTX therapy, in a department of rheumatology, from 1985 to 1992. We studied 124 patients for a mean period of 23 months (range, 1 to 85 months). The patients were treated for rheumatoid arthritis (115 patients), psoriatic rheumatism (6 patients), or systemic lupus erythematosus (3 patients). MTX treatment was begun after all conventional treatments, including salazopyrine, D-penicillamine, and gold therapy, had led to
Incidence of MTX Pneumonitis
Four patients developed MTX pneumonitis according to criteria from Searles and Mc Kendry;16 three had a definite diagnosis, defined as the presence of at least six criteria; one had a probable diagnosis with five criteria. Two other cases were not taken into account as the criteria were insufficient: one patient with four criteria (possible diagnosis) and one patient with three criteria. This result corresponds to an incidence of 4 cases among 124 patients (3.2%). Drug-induced bronchospasm was
Discussion
Most of the studies estimating the frequency of MTX pneumonitis concern the antineoplastic use of high-dose MTX and are retrospective studies.6 It has been considered that a low-dose MTX regimen may reduce the incidence of such problems. Varying incidences are reported in studies on the use of MTX in the treatment of rheumatoid arthritis: from 0.3%22 to 11.6%13 in retrospective studies, and from 0.7%23 to 7.7%24 in prospective studies (review in reference 14). We personally observed four cases
ACKNOWLEDGMENTS
We thank Louis Ayzac, MD, for statistical analysis. We thank Jérome Dumortier, MD, Line Lamboley, MD, and Maurice Bouvier, MD, who took part in the study. We thank Jean-François Cordier, MD, for critical comments on the manuscript.
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Methotrexate
2020, Comprehensive Dermatologic Drug Therapy, Fourth EditionThoracic Manifestations of Rheumatoid Arthritis
2019, Clinics in Chest MedicineCitation Excerpt :Onset typically occurs early in the course of MTX therapy (often within the first year),141 resolves after discontinuation of the drug and administration of corticosteroids,142 and has been reported in other conditions treated with MTX, such as psoriatic arthritis.143 It is unclear if preexisting RA-ILD increases the risk of MTX pneumonitis, as some studies have found up to 7.5 times increased risk,144,145 whereas others suggest no association.146,147 There is currently no conclusive evidence that pulmonary disease progresses in patients with RA-ILD on MTX who do not develop pneumonitis.140,148
Drug-induced pulmonary diseases
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