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Infections during low-dose methotrexate treatment in rheumatoid arthritis
A M Boerbooms1, P J Kerstens, J W van Loenhout
1Department of Rheumatology, University Hospital Nijmegen, The Netherlands.
Abstract:
We studied the infection rate in patients with rheumatoid arthritis (RA) treated with low-dose methotrexate (MTX) in a 6-year open prospective study and in a 12-month randomized double blind trial comparing MTX with azathioprine (AZA) that was followed by a 3-year open prospective study. The literature on infections during low dose MTX in RA was reviewed. We also did a search for therapy-related opportunistic infections in RA and in MTX-treated psoriasis and psoriatic arthropathy patients. In our studies the infection rate during MTX treatment was higher in severe RA than in moderate RA. In severe RA there were often 2 infections simultaneously. The majority of the infections occurred in the first 1.5 years of treatment. There was no difference in the infection rate of MTX and AZA in the comparative trial. In the literature the infection rate was highest in short-term double-blind studies. Opportunistic infections are increasingly reported in RA treated with MTX and rarely with AZA, cyclosporine A, and cyclophosphamide or in MTX treated psoriasis and psoriatic arthropathy. In RA it appears that the initial period of treatment with MTX is the most vulnerable phase for infections, with the exception of opportunistic infections, which are not limited to a certain treatment period. Probably there are more MTX-associated infections in severe RA than in moderate RA.
Insights
Rheumatoid arthritis patients on low-dose methotrexate (MTX) face higher infection risks, especially in severe cases during the initial treatment phase. Opportunistic infections are also a concern with MTX therapy.
Area of Science:
- Rheumatology
- Infectious Diseases
- Pharmacology
Background:
- Rheumatoid arthritis (RA) treatment often involves disease-modifying antirheumatic drugs (DMARDs).
- Methotrexate (MTX) is a common first-line DMARD for RA.
- Understanding infection risks associated with MTX is crucial for patient safety.
Purpose of the Study:
- To investigate infection rates in rheumatoid arthritis (RA) patients treated with low-dose methotrexate (MTX).
- To compare MTX with azathioprine (AZA) regarding infection risk.
- To review literature on therapy-related opportunistic infections in RA and related conditions.
Main Methods:
- A 6-year open prospective study of RA patients on low-dose MTX.
- A 12-month randomized double-blind trial comparing MTX and AZA, followed by a 3-year open study.
- Literature review for infections in RA, psoriasis, and psoriatic arthropathy patients on MTX and other DMARDs.
Main Results:
- Infection rates were higher in severe RA patients compared to moderate RA patients on MTX.
- Most infections occurred within the first 1.5 years of MTX treatment.
- No significant difference in infection rates between MTX and AZA in the comparative trial.
- Opportunistic infections are increasingly reported with MTX in RA and related conditions.
Conclusions:
- The initial treatment period with MTX poses the highest risk for infections in RA patients.
- Severe RA patients may experience a greater number of infections during MTX therapy.
- Opportunistic infections associated with MTX are a significant concern and not limited to the early treatment phase.