REVIEW - Benefit and risk of MTX treatment of rheumatoid arthritis

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Clinical and Experimental Rheumatology

2004

Benefit and risk of MTX treatment of rheumatoid arthritis

Excerpt:

Respiratory system

MTX-induced lung disease is a rare,

but potentially life-threatening complication,

and the rapid evaluation of pulmonary

symptoms in patients receiving

MTX is crucial (133). The predominant

symptoms of MTX pulmonitis are the

subacute development of dyspnea and

dry non-productive cough and fever,

accompanied by headache, malaise, cyanosis,

hypoxemia and restrictive pulmonary

function changes (134). Rales

may be present on physical examination,

and interstitial infiltrates may be

seen on chest radiographs. Lung biopsy

may reveal hypersensitivity pneumonitis

characterized by massive interstitial

and alveolar infiltration with inflammatory

cells, predominantly lymphocytes,

and granuloma formation with

giant cells (135). Other causes of pulmonary

disease, e.g. nosocomial infections

(136-138), must be excluded before

a diagnosis of MTX-induced

pneumonitis can be established.

Pulmonary complications occurred in

2.1% to 6.8% of patients (140-142), but

some clinical studies did not encounter

any pulmonary complications (96, 143).

Between 1981 and 1993, 27 patients

with MTX pneumonitis were identified

in 6 clinical centers, and reports on 68

patients were found in the medical literature

(134). The mortality rate in these

patients was approximately 17.5%

(134). Pre-existing lung disease does

not seem to pre-dispose to MTX pulmonary

adverse events (139, 140). Furthermore,

there is no evidence to suggest

that low-dose MTX is associated

with chronic interstitial lung disease

(144).

http://www.clinexprheumatol.org/pdf/vol22/s35/s35_pdf/14rau.pdf

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