Clinical, laboratory, radiographic, and histopathologic features of methotrexate-associated lung injury in patients with rheumatoid arthritis. A multicenter study with literature review
| Autor: | Michael E. Weinblatt, E. William St. Clair, Constantine A. Axiotis, Ronald W. Alexander, Maurizio Macaluso, Joel M. Kremer, G. J. Walker Smith, Graciela S. Alarcón, John S. Sundy, William R. Palmer, Grant W. Cannon, Mari V. Kaymakcian |
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| Rok vydání: | 1997 |
| Předmět: |
Lung Diseases
Male medicine.medical_specialty medicine.medical_treatment Immunology Arthritis Lung injury Gastroenterology Arthritis Rheumatoid Cohort Studies Rheumatology Internal medicine medicine Humans Immunology and Allergy Pharmacology (medical) Lung Aged Chemotherapy business.industry Respiratory disease Middle Aged medicine.disease Surgery Radiography Methotrexate Antirheumatic Agents Rheumatoid arthritis Cohort Female business medicine.drug Cohort study |
| Zdroj: | Arthritis & Rheumatism. 40:1829-1837 |
| ISSN: | 1529-0131 0004-3591 |
| DOI: | 10.1002/art.1780401016 |
| Popis: | Objective To describe the clinical, laboratory, radiologic, and histopathologic features of methotrexate (MTX)-induced lung injury in a combined cohort of selected patients with rheumatoid arthritis (RA) and all cases reported in the English-language literature. Methods Retrospective combined cohort review and abstraction from the medical literature. Case reports were obtained from 6 centers that had 4 or more cases of potential MTX lung injury per site. RA patients who were seen between 1981 and 1993 and who satisfied predetermined criteria for the presence of MTX lung injury were identified. Results Twenty-seven patients satisfied the criteria for definite MTX lung injury, and 2 for probable MTX lung injury. Predominant clinical features of MTX lung injury included shortness of breath in 27 patients (93.1%), which was present for 23.5 +/- 22.3 days (mean +/- SD), cough in 24 (82.8%), present for 26.9 +/- 28.5 days, and fever in 20 (69.0%), present for 10.4 +/- 12.8 days. Five patients (17.2%) died, compared with 12 of 68 (17.6%) reported in the medical literature. Four of the 6 patients who were re-treated with MTX after an initial pulmonary event developed recurrent lung toxicity, resulting in 2 deaths, compared with a recurrence rate of 3 of 6 in the literature. Conclusion MTX lung injury is most often a subacute process, in which symptoms are commonly present for several weeks before diagnosis. Approximately 50% of the cases are diagnosed within 32 weeks from initiation of MTX treatment. A patient who recovers from MTX lung injury should not be re-treated. Earlier recognition and drug withdrawal may avoid the serious and sometimes fatal outcome that has been observed in this and other studies. |
| Databáze: | OpenAIRE |
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