Methotrexate and triamterene---a potentially fatal combination?

Abstract

Maternal age and the risk of developing ankylosing spondylitisWe read with interest the article by Weinreich and colleagues.1 They showed that transgenic mice born to mothers aged 8 months or older had a significantly lower frequency of murine ankylosing enthesopathy than mice born to younger mothers. They speculated that an age related increase in maternal antibody levels resulted in increasing protection of oVspring against a ubiquitous, potentially arthritogenic, micro-organism. In humans, as in the mouse model, environmental factors must influence the development of ankylosing spondylitis (AS). We sought evidence that the age of conception in women with AS influenced the risk of their oVspring developing disease.We collected data from 3473 patients with AS, regarding the age, and AS status, of relatives. Nine hundred and sixty two were female, male: female ratio 2.6:1. Six hundred and sixty five were recruited from the Royal National Hospital for Rheumatic Diseases (RNHRD), 2779 from the National Ankylosing Spondylitis Society (NASS), and 29 were relatives of RNHRD patients or NASS members, but were not RNHRD patients or NASS members themselves. Those from the RNHRD have been confirmed, by a rheumatologist, as having AS according to the New York criteria.2 The diagnosis of AS in the overall patient population has been validated in three separate cohorts in which 100% of 146 patients had AS (personal communications M Brown, Oxford), 92.7% of 330 patients had AS (personal communications K Gomez, Bath), and 96% of 50 patients had AS.3 Data were available for 39 pairs in which both mother and oVspring had AS (21 mother:daughter pairs, 18 mother:son pairs). There were no families with data available for more than one mother:child pair. The higher than expected ratio of mother:daughter to mother:son pairs is the subject of an ongoing investigation. From our data base we chose 39 control pairs, where the mother had AS and the oVspring did not, by matching the oVspring for sex and age to the nearest year. We were able to match the oVspring for birth rank in 37 cases (20 mother:daughter pairs, 17 mother:son pairs). The oVspring were not matched for sibship size. The maternal ages at birth of oVspring are shown (see table 1). Using paired t tests, we compared maternal ages at childbirth in the groups where the oVspring had AS, and where the oVspring did not have AS. The diVerence in the maternal age at childbirth was significant only when comparing mothers of sons with AS and mothers of sons without AS (p = 0.04; diVerence in mean maternal age at childbirth = 2.78 years). Mothers with AS, whose sons had AS, had given birth at a older age than those whose sons did not have AS.Unlike the situation in the murine model, we find no evidence that increasing maternal age in humans is protective against the development of AS. However, the number of pairs available for our analysis was small. The influence of age at conception, on the development of AS in the oVspring, remains an interesting area that deserves further attentio...

Methotrexate Drug Interactions in the Treatment of Rheumatoid Arthritis: A Systematic Review

“…The proton pump inhibitor lanzoprazole has been thought to play a role in one case of cytopenia, and the H 2 -antagonists cimetidine and ranitidine have been implicated in one and 4 cases of cytopenia, respectively 27,29,38,39 . Triamterene, rofecoxib, nicotinic acid, glafenine, and angiotensin-converting enzyme inhibitors are other medications that have rarely been reported 29,33,[40][41][42] . The concomitant use of multiple medications was also mentioned as a factor precipitating cytopenia in a number of case reports 27,30,37,[43][44][45][46] .…”