Methotrexate, rheumatoid arthritis and infection risk: what is the evidence?

Area of Science:

• Rheumatology
• Immunology
• Infectious Diseases

Background:

• Methotrexate (MTX) is a cornerstone therapy for rheumatoid arthritis (RA).
• A clinical perception exists that MTX use increases infection risk and severity in RA patients.
• Evidence-based management strategies for MTX in infected RA patients are needed.

Purpose of the Study:

• To critically review existing literature on the association between MTX and infection in RA.
• To evaluate the actual risk and severity of infections in RA patients treated with MTX.
• To provide clinical recommendations for managing MTX therapy during active infections in RA patients.

Main Methods:

• Systematic literature search of studies investigating MTX and infection in RA.
• Analysis of reported infection rates, types, and severity in MTX-treated RA cohorts.
• Synthesis of data to assess the MTX-infection relationship and inform clinical practice.

Main Results:

• Review of published data on MTX and infection risk in rheumatoid arthritis patients.
• Assessment of the impact of MTX on infection severity.
• Identification of key considerations for managing MTX in the context of infection.

Conclusions:

• The actual risk and severity of infections in RA patients on MTX require careful evaluation.
• Recommendations for managing MTX in RA patients experiencing infections are proposed.
• Optimizing MTX use while mitigating infection risk is crucial for RA patient care.