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Related Experiment Videos

Pulmonary function in patients receiving long-term low-dose methotrexate

V Cottin1, J Tébib, B Massonnet

  • 1Service de Pneumologie, Lyon, France.

Chest
|April 1, 1996
PubMed
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Methotrexate (MTX) treatment for arthritis can cause pneumonitis. Periodic pulmonary function tests do not predict MTX pneumonitis in asymptomatic patients, despite minor subclinical lung function changes.

Area of Science:

  • Rheumatology
  • Pulmonology
  • Pharmacology

Background:

  • Methotrexate (MTX) is a common treatment for rheumatoid arthritis.
  • Acute interstitial pneumonitis is a significant pulmonary side effect of MTX therapy.
  • Early detection of MTX-induced pneumonitis is crucial for patient safety.

Purpose of the Study:

  • To determine the incidence of MTX-induced pneumonitis in patients on low-dose long-term MTX for chronic arthritis.
  • To evaluate the utility of periodic pulmonary function tests (PFTs) in detecting MTX pneumonitis before symptom onset.
  • To identify subclinical pulmonary function abnormalities in asymptomatic MTX-treated patients.

Main Methods:

  • 124 patients on low-dose MTX for rheumatologic diseases underwent PFTs, including diffusing capacity for carbon monoxide (DCO).

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  • Tests were conducted at baseline, 3 months, 6 months, and then every 6 months.
  • Mean treatment duration was 23 months.

    • Main Results:

    • Four cases of MTX pneumonitis were diagnosed (3.2% incidence) among six patients who stopped MTX due to symptoms.
    • No significant PFT decrease preceded clinical MTX pneumonitis symptoms; tests could not predict this adverse effect.
    • Asymptomatic patients showed statistically significant decreases in FVC (-2.2%), FEV1 (-5.0%), and DCO/VA (-4.8%), but not DCO.

    Conclusions:

    • Low-dose long-term MTX treatment is associated with minor subclinical pulmonary function alterations in asymptomatic patients.
    • Periodic PFTs are not effective in detecting MTX-induced pneumonitis before clinical symptoms arise.
    • Systematic performance of PFTs during MTX treatment is not recommended.