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Clinical characteristics of patients with rheumatoid arthritis and methotrexate induced pneumonitis
1Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Objective:
To determine the clinical features of methotrexate (MTX) pneumonitis in patients treated for rheumatoid arthritis (RA).
Methods:
The medical records of 284 patients with RA who had been treated with oral MTX (mean followup 33.2 mo) were reviewed retrospectively.
Results:
MTX induced interstitial pneumonitis developed in 6 patients (2.1%). The affected patients were significantly older than those without MTX pneumonitis (67.3 +/- 9.8 vs 52.4 +/- 12.6 yrs, respectively; p < 0.005). The cumulative MTX dose ranged from 65 to 580 mg at the time pneumonitis developed. Five of the patients (83%) had preexisting interstitial abnormalities, while only 29 of the 278 patients without MTX pneumonitis (10%) had such abnormalities (p < 0.001). The frequency of adverse effects due to previous treatment with disease modifying antirheumatic drugs (DMARD) was 66.7% in MTX pneumonitis patients and 14.3% in the other 278 patients (p < 0.01).
Conclusion:
Advanced age, preexisting interstitial abnormalities, and previous adverse reactions to DMARD may be associated with MTX pneumonitis. Patients with these characteristics require careful monitoring during MTX therapy.
Insights
Methotrexate (MTX) pneumonitis in rheumatoid arthritis (RA) patients is linked to older age and prior lung issues. Careful monitoring is crucial for those with these risk factors during MTX therapy.
Area of Science:
- Rheumatology
- Pulmonology
- Clinical Pharmacology
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease.
- Methotrexate (MTX) is a common disease-modifying antirheumatic drug (DMARD) used for RA.
- MTX can cause interstitial pneumonitis, a serious lung complication.
Purpose of the Study:
- To identify clinical features associated with MTX-induced pneumonitis in RA patients.
- To determine risk factors for developing MTX pneumonitis.
Main Methods:
- Retrospective review of medical records of 284 RA patients treated with oral MTX.
- Analysis of patient demographics, MTX dosage, and history of interstitial abnormalities and DMARD adverse effects.
Main Results:
- MTX pneumonitis occurred in 2.1% of patients (6 out of 284).
- Affected patients were significantly older (mean 67.3 yrs) and more likely to have pre-existing interstitial abnormalities (83%) and prior DMARD adverse effects (66.7%).
- Cumulative MTX doses ranged from 65 to 580 mg at pneumonitis onset.
Conclusions:
- Advanced age, pre-existing interstitial lung abnormalities, and previous adverse reactions to DMARDs are associated with MTX pneumonitis.
- RA patients with these risk factors require vigilant monitoring during MTX treatment.