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Interstitial pneumonitis associated with infliximab therapy
Edith Villeneuve1, Anne St-Pierre, Boulos Haraoui
1Department of Rheumatology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
The Journal of Rheumatology
|April 20, 2006
Summary
Interstitial pneumonitis is a rare complication of methotrexate (MTX). A rheumatoid arthritis patient on MTX developed severe lung issues after infliximab, suggesting MTX pulmonary toxicity potentiation.
Area of Science:
- Rheumatology
- Pulmonology
- Clinical Pharmacology
Background:
- Methotrexate (MTX) is a common disease-modifying antirheumatic drug (DMARD) used for rheumatoid arthritis (RA).
- Interstitial pneumonitis is a known, albeit rare, adverse effect associated with MTX therapy.
- Biologic agents like infliximab are often used in combination with MTX for refractory RA.
Observation:
- A case study of a rheumatoid arthritis patient with over 3 years of MTX treatment is presented.
- The patient developed severe interstitial pneumonitis following their third infliximab infusion.
- This clinical presentation prompted a review of similar reported cases in the literature.
Findings:
- The patient's severe interstitial pneumonitis occurred in the context of combined MTX and infliximab therapy.
- Review of existing literature identified other cases suggesting a potential link between infliximab and MTX-induced lung toxicity.
- Infliximab administration may exacerbate or potentiate the known pulmonary risks of methotrexate.
Implications:
- Clinicians should be vigilant for pulmonary toxicity in RA patients receiving concurrent MTX and infliximab.
- The findings suggest a need for careful monitoring of respiratory symptoms in patients on this combination therapy.
- Further research may be warranted to elucidate the mechanism by which infliximab might potentiate MTX pulmonary toxicity.