Objective. Methotrexate has shown efficacy for the treatment of several diseases, especially rheumatoid arthritis (RA). Methotrexate has also been implicated as a causative agent in interstitial lung disease. Patients with RA may develop pulmonary manifestations of their disease and are at increased risk of respiratory infection. The aim of this study was to evaluate the relative risk (RR) of pulmonary disease among patients with RA treated with methotrexate.Methods. We searched the PubMed and Cochrane databases (publication dates January 1, 1990 to February 1, 2013) for double-blind, randomized, controlled trials of methotrexate versus placebo or active comparator agents in adults with RA. Studies with <100 subjects or with a duration of <24 weeks were excluded. Two investigators independently searched both databases, and all of the investigators reviewed the selected studies. We compared differences in the RR using the Mantel-Haenszel random-effects method.Results. A total of 22 studies with 8,584 participants met the inclusion criteria. Heterogeneity across studies was not significant (I 2 ‫؍‬ 3%), allowing combination of the trial results. Methotrexate was associated with an increased risk of all adverse respiratory events (RR 1.10, 95% confidence interval [95% CI] 1.02؊1.19) and respiratory infection (RR 1.11, 95% CI 1.02؊1.21). Patients treated with methotrexate were not at increased risk of death due to lung disease (RR 1.53, 95% CI 0.46؊5.01) or noninfectious respiratory events (RR 1.02, 95% CI 0.65؊1.60). A subgroup analysis of studies in which pneumonitis was described revealed an increased risk associated with methotrexate (RR 7.81, 95% CI 1.76؊34.72).Conclusion. Our study demonstrated a small but significant increase in the risk of lung disease in patients with RA treated with methotrexate compared with other disease-modifying antirheumatic drugs and biologic agents.

ObjeCtive To evaluate the relative risk of pulmonary disease among patients with psoriasis, psoriatic arthritis, and inflammatory bowel disease treated with methotrexate.

Illness perceptions have significant implications for adaptation to illness and they outweigh the impact of medical disease status on depression, physical function and pain. Health interventions based on understanding and modifying perceptions of illness may prove useful in facilitating patient well-being.

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Conventional radiography lacks sensitivity in early rheumatoid disease. MRI with its advantages of soft tissue discrimination and multiplanar imaging facility might detect earlier disease. This study compares the MR images and conventional radiographs of 11 rheumatoid patients' wrists and carpi. In all cases, erosions were more extensive and numerous on the MR images compared to plain radiographs. MR is useful in detecting early aggressive disease and in monitoring the response to treatments.