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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 f 22.3 days

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Objective. To compare the frequency of lifetime psychiatric disorders among 3 groups of subjects: patients with fibromyalgia syndrome (FMS) from a tertiary care setting, community residents with FMS who had not sought medical care for their FMS symptoms (' 'FMS nonpatients' '), and healthy controls. Fibromyalgia syndrome (FMS) is a relatively common, chronic musculoskeletal pain disorder of unknown cause that affects -15% of rheumatology clinic patients (1). The etiopathogenesis of FMS is not understood, but peripheral factors (e.g., muscle tissue abnormalities) and central factors (e.g., ,neurohormonal changes, abnormal regional cerebral blood flow) have been associated with symptom onset ( 2 4 ) .Psychiatric disorders and psychological distress represent one set of central factors that may influence the behavior of patients with FMS. Some investigators have suggested that psychiatric illness also may play a role in the development of FMS. For example, Hudson and colleagues recently utilized a structured interview, the Diagnostic Interview Schedule, to assess lifetime rates of psychiatric diagnoses in patients with FMS or rheumatoid arthritis (RA) in a tertiary care rheumatology clinic. Higher rates both of major mood disorders (64% versus 22%) and of panic disorder or agoraphobia (33% versus 11%) were found in FMS versus RA patients. Moreover, for the majority of diagnoses, initial symptoms predated the onset of pain among the FMS patients (5,6). Although these observations were based on the interview responses of patients who may not have been representative of community residents with FMS, it was concluded that FMS may share a common pathophysiology with depressive and anxiety disorders.Wolfe and colleagues recently examined psychological distress in FMS clinic patients and community residents with FMS (7). They found high levels of psychological distress in both groups and therefore suggested that psychological distress is intrinsically related to the FMS syndrome. However, the cornmu-

We administered the Coping Strategies Questionnaire (CSQ) to 80 patients with fibromyalgia (FM) to determine the relationship between coping strategies and functional disability. A principal components factor analysis revealed two dimensions of patients' CSQ responses: Coping Attempts and Catastrophizing. Coping Attempts consists of five scales: Reinterpreting Pain, Ignoring Pain Sensations, Diverting Attention, Coping Self-Statements and Increasing Activity Level. Catastrophizing is comprised solely of the CSQ Catastrophizing scale. Both coping strategy dimensions were significantly related to patients' disability scores on the Sickness Impact Profile even after controlling for demographic and clinical variables as well as neuroticism. Coping Attempts was associated with higher levels of Physical (P < 0.05) and Total Disability (P < 0.01), and lower levels of Psychosocial Disability (P < 0.05). Catastrophizing was associated with higher levels of Total Disability (P < 0.01). These relationships suggest that investigators should attempt to identify Coping Attempts strategies that best reduce patients' psychological distress in the laboratory. It then may be possible to teach patients to use these strategies to reduce distress in their home and work environments.