Methotrexate and Lung Disease in Rheumatoid Arthritis: A Meta‐Analysis of Randomized Controlled Trials

Conway, Richard; Low, Candice; Coughlan, Robert J.; O’Donnell, Martin; Carey, John J.

doi:10.1002/art.38322

Cited by 202 publications

(156 citation statements)

References 59 publications

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“…There have been reports of lymphoproliferative diseases developing in the setting of methotrexate treatment, with disease regression once medication is stopped. A recent meta-analysis of 22 studies involving rheumatoid arthritis patients treated with methotrexate (n=4544) versus other agents (including disease modifying anti-rheumatic drugs and biological agents) found a small increase in risk of respiratory infections (RR 1.11, 95% CI 1.02-1.21), but not in noninfectious complications, such as pneumonitis, or death from pulmonary causes among those treated with methotrexate [95].…”

Section: Methotrexatementioning

confidence: 99%

Rheumatoid arthritis-associated lung disease

et al. 2015

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Section: Methotrexatementioning

confidence: 99%

Rheumatoid arthritis-associated lung disease

et al. 2015

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“…Most generally used disease-modifying antirheumatic drugs (DMARDs), methotrexate (MTX), is suspicious for causal agent of lung disease. According to recent meta-analysis of randomized controlled trials, MTX increased the risk of lung disease significantly compared to other DMARDs and biologic agents [12]. But the amount of risk increase was very small (10%) and the scope of lung diseases in this meta-analysis included all adverse respiratory events including infection.…”

Section: Lung Disease In Rheumatoid Arthritismentioning

confidence: 90%

Lung Disease in Rheumatoid Arthritis

Lee

2016

J Rheum Dis

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“…Studies have shown that pneumonitis may complicate low-dose MTX therapy as well (3). A recent meta-analysis showed that the risk of pneumonitis is significantly increased in RA patients treated with MTX (relative risk 7.8), but did not show an increased risk of death due to lung disease in this population (4). Common findings on chest radiographs in MTX pneumonitis include interstitial or mixed interstitialalveolar infiltrates; HRCT usually demonstrates multifocal ground-glass opacities.…”

Section: Differential Diagnosismentioning

confidence: 97%

Respiratory Distress and Nephropathy in a Young Male With Small‐Joint Polyarthritis

Korsten

Konig

Müller

et al. 2016

Arthritis Care & Research

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History of the present illness. A 27-year-old man presented to our department with a 4-week history of worsening fatigue, malaise, and painful swelling of his wrists and finger joints. He further complained of new-onset progressive dyspnea with nonproductive cough, subfebrile temperatures, and proximal muscle weakness in his lower extremities in the last 10 days. Except for the arthritis, he had not experienced these symptoms in the past. Two months prior to admission, he was seen for the first time by a rheumatologist. At that time, he reported severe pain and stiffness in his hands, particularly at night, but no breathing or muscle difficulties. Laboratory tests at the rheumatologist's office showed increased C-reactive protein (CRP) levels and high-titer anti-cyclic citrullinated peptide (CCP) antibodies. Plain radiographs demonstrated an erosion at the fifth metatarsal head of his right foot. He was diagnosed with rheumatoid arthritis (RA) and started on oral methotrexate (MTX) and prednisone. Medical historyThe patient reported having intermittent arthralgias in his hands, elbows, and hips for the past 3 years. He had been treated with nonsteroidal antiinflammatory drugs and oral glucocorticoids as needed by his primary care provider. In the last couple of months, he increasingly experienced painful arthritis in his hands. After being diagnosed with RA, oral treatment with MTX 15 mg weekly and prednisone 50 mg daily (followed by slow tapering) was initiated, along with prophylactic pantoprazole (40 mg daily) and folic acid (5 mg weekly). He was adherent to the therapy and denied taking over-the-counter drugs or supplements. There were no other medical or surgical illnesses.Social and family history. He used to work as a gardener. His social history was negative for smoking and alcohol abuse. He denied recent travel or contact with someone with similar symptoms. His grandmother had a diagnosis of RA, but his family history was otherwise negative for autoimmune or pulmonary disorders. Review of systems.There was no history of photosensitivity, rash, sicca symptoms, Raynaud's phenomenon, back pain, hemoptysis, dysphagia, or diarrhea.Physical examination. On admission, his temperature was 37.08C, blood pressure 130/80 mm Hg, pulse 105 beats per minute, respiratory rate 24 breaths per minute, and oxygen saturation of 95% while breathing ambient air. There was no lymphadenopathy, jaundice, or cyanosis. Auscultation of the lung revealed fine bibasilar crackles. Cardiac (except tachycardia), abdominal, and neurologic examinations were unremarkable. His wrists, metacarpophalangeal, and proximal interphalangeal joints of both hands were swollen and tender with limited range of motion. There was isolated weakness of the thigh muscles (4/5), but no muscle wasting or fasciculations.Laboratory tests and imaging. Initial workup showed a hemoglobin level of 14.5 gm/dl (normal range [NR] 13.5-17.5), white blood cell count of 13.3 3 10 3 /ml (NR 4-11 3 10 3 ), and platelets of 273 3 10 3 /ml (NR 150-350 3 10 3 ). The differe...

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Methotrexate and Lung Disease in Rheumatoid Arthritis: A Meta‐Analysis of Randomized Controlled Trials

Cited by 202 publications

References 59 publications

Rheumatoid arthritis-associated lung disease

Rheumatoid arthritis-associated lung disease

Lung Disease in Rheumatoid Arthritis

Respiratory Distress and Nephropathy in a Young Male With Small‐Joint Polyarthritis

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