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Risk factors for methotrexate-induced lung injury in patients with rheumatoid arthritis. A multicenter, case-control

G S Alarcón1, J M Kremer, M Macaluso

  • 1University of Alabama, Birmingham School of Medicine, USA.

Annals of Internal Medicine
|September 1, 1997
PubMed
Abstract

Insights

Methotrexate toxicity can cause lung injury in rheumatoid arthritis patients. Older age, diabetes, rheumatoid pleuropulmonary involvement, prior DMARD use, and hypoalbuminemia are key risk factors. Identifying these aids in monitoring and managing high-risk individuals.

Area of Science:

  • Rheumatology
  • Pulmonology
  • Clinical Pharmacology

Background:

  • Methotrexate (MTX) is a cornerstone therapy for rheumatoid arthritis (RA).
  • MTX toxicity, particularly lung injury, limits its clinical utility.
  • Identifying patients at risk for MTX-induced lung injury (MTX-ILI) is crucial for safe RA management.

Purpose of the Study:

  • To investigate potential risk factors associated with methotrexate-induced lung injury (MTX-ILI) in patients with rheumatoid arthritis (RA).
  • To identify specific patient characteristics and treatment-related factors that predispose individuals to MTX-ILI.

Main Methods:

  • A case-control study was conducted across multiple rheumatology practices.
  • Participants included RA patients with and without MTX-induced lung injury.
  • Data collected encompassed sociodemographic, lifestyle, medical history, RA characteristics, and MTX treatment details.

Main Results:

  • Older age (OR, 5.1), diabetes (OR, 35.6), rheumatoid pleuropulmonary involvement (OR, 7.1), prior disease-modifying antirheumatic drug (DMARD) use (OR, 5.6), and hypoalbuminemia (OR, 19.5) were significant predictors of MTX-ILI.
  • Prior DMARD use and hypoalbuminemia demonstrated very large attributable risks.
  • Cases were older than controls (61.5 vs. 54.5 years).

Conclusions:

  • Understanding these risk factors provides a basis for targeted monitoring of high-risk RA patients undergoing MTX therapy.
  • Proactive identification and management strategies can mitigate the risk of MTX-induced lung toxicity.
  • This knowledge can improve patient outcomes and facilitate safer MTX use in RA.

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