Methotrexate-induced lung damage in a patient with rheumatoid arthritis
- Authors: Ponomareva L.A.1, Gurova D.V.1, Popova E.N.1, Chebotareva N.V.1, Bondarenko I.B.1, Moiseev S.V.1
-
Affiliations:
- Sechenov First Moscow State Medical University (Sechenov University)
- Issue: Vol 93, No 3 (2021)
- Pages: 295-299
- Section: Clinical notes
- URL: https://journals.rcsi.science/0040-3660/article/view/64973
- DOI: https://doi.org/10.26442/00403660.2021.03.200656
- ID: 64973
Cite item
Full Text
Abstract
We herein report a case of interstitial lung disease secondary to the use of methotrexate in a patient with rheumatoid arthritis. Differential diagnosis between pneumonitis caused by methotrexate in patients treated with basic methotrexate therapy and interstitial pulmonary disease associated with rheumatoid arthritis is based on the clinical examination and instrumental data. The main condition for favorable clinical outcome in all drug-induced lung disease is drug withdrawal, what was proven in our report.
Full Text
##article.viewOnOriginalSite##About the authors
Liubov A. Ponomareva
Sechenov First Moscow State Medical University (Sechenov University)
Email: ela12@yandex.ru
ORCID iD: 0000-0002-3179-470X
студентка Международной школы «Медицина будущего»
Russian Federation, MoscowDaria V. Gurova
Sechenov First Moscow State Medical University (Sechenov University)
Email: ela12@yandex.ru
ORCID iD: 0000-0001-8232-3679
студентка Института клинической медицины им. Н.В. Склифосовского
Russian Federation, MoscowElena N. Popova
Sechenov First Moscow State Medical University (Sechenov University)
Email: ela12@yandex.ru
ORCID iD: 0000-0001-5164-4621
д.м.н., проф. каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины им. Н.В. Склифосовского
Russian Federation, MoscowNatalia V. Chebotareva
Sechenov First Moscow State Medical University (Sechenov University)
Author for correspondence.
Email: ela12@yandex.ru
д.м.н., проф. каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины им. Н.В. Склифосовского
Russian Federation, MoscowInna B. Bondarenko
Sechenov First Moscow State Medical University (Sechenov University)
Email: ela12@yandex.ru
ORCID iD: 0000-0002-4111-1175
к.м.н., ассистент каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины им. Н.В. Склифосовского
Russian Federation, MoscowSergey V. Moiseev
Sechenov First Moscow State Medical University (Sechenov University)
Email: ela12@yandex.ru
ORCID iD: 0000-0002-7232-4640
д.м.н., проф., зав. каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины им. Н.В. Склифосовского
Russian Federation, MoscowReferences
- Marcellino K, Kelly WN. Potential risks and prevention. Part 3: Drug-induced threats to life. Am J Health Syst Pharm. 2001;58(15):1399-405. doi: 10.1093/ajhp/58.15.1399
- Thickett DR, Millar AB. Drug-induced antisynthetase syndrome. Postgrad Med J. 1997;73(857):165-6. doi: 10.1136/pgmj.73.857.165
- Lengyel C, Boros I, Várkonyi T, et al. Amiodarone-induced pulmonary fibrosis. Orv Hetil. 1996;137(32):1759-62.
- Fauroux B, Clément A, Tournier G. Pulmonary toxicity of drugs and thoracic irradiation in children. Rev Mal Respir. 1996;13(3):235-42.
- Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update [published online ahead of print, 2020 Jan 22]. Ann Rheum Dis. 2020; annrheumdis-2019-216655. doi: 10.1136/annrheumdis-2019-216655
- Weinblatt ME. Methotrexate in rheumatoid arthritis: a quarter century of development. Trans Am Clin Climatol Assoc. 2013;124:16-25.
- Doyle TJ, Dellaripa PF. Lung Manifestations in the Rheumatic Diseases. Chest. 2017;152(6):1283-95. doi: 10.1016/j.chest.2017.05.015
- Chansakul T, Dellaripa PF, Doyle TJ, Madan R. Intra-thoracic rheumatoid arthritis: Imaging spectrum of typical findings and treatment related complications. Eur J Radiol. 2015;84(10):1981-91. doi: 10.1016/j.ejrad.2015.07.008
- Roubille C, Haraoui B. Interstitial lung diseases induced or exacerbated by DMARDS and biologic agents in rheumatoid arthritis: a systematic literature review. Semin Arthritis Rheum. 2014;43(5):613-26.doi: 10.1016/j.semarthrit.2013.09.005
- Alarcón GS, Kremer JM, Macaluso M, et al. Risk factors for methotrexate-induced lung injury in patients with rheumatoid arthritis. A multicenter, case-control study. Methotrexate-Lung Study Group. Ann Intern Med. 1997;127(5): 356-64.doi: 10.7326/0003-4819-127-5-199709010-00003
- Atzeni F, Boiardi L, Sallì S, et al. Lung involvement and drug-induced lung disease in patients with rheumatoid arthritis. Expert Rev Clin Immunol. 2013;9(7):649-57. doi: 10.1586/1744666X.2013.811173
- Pavy S, Constantin A, Pham T, et al. Methotrexate therapy for rheumatoid arthritis: clinical practice guidelines based on published evidence and expert opinion. Joint Bone Spine. 2006;73(4):388-95. doi: 10.1016/j.jbspin.2006.01.007
- Conway R, Low C, Coughlan RJ, et al. Methotrexate and lung disease in rheumatoid arthritis: a meta-analysis of randomized controlled trials. Arthritis Rheumatol. 2014;66(4):803-12. doi: 10.1002/art.38322
- Salehi M, Miller R, Khaing M. Methotrexate-induced Hypersensitivity Pneumonitis appearing after 30 years of use: a case report. J Med Case Rep. 2017;11(1):174. doi: 10.1186/s13256-017-1333-0
- Yamakawa H, Yoshida M, Takagi M, Kuwano K. Late-onset methotrexate-induced pneumonitis with neutrophilia in bronchoalveolar lavage fluid. BMJ Case Rep. 2014;2014:bcr2014206123.doi: 10.1136/bcr-2014-206123
- Dong H, Julien PJ, Demoruelle MK, et al. Interstitial lung abnormalities in patients with early rheumatoid arthritis: A pilot study evaluating prevalence and progression. Eur J Rheumatol. 2018;6(4):193-8. doi: 10.5152/eurjrheum.2019.19044
- Furukawa H, Oka S, Shimada K; Rheumatoid Arthritis-Interstitial Lung Disease Study Consortium, Tsuchiya N, Tohma S. HLA-A*31:01 and methotrexate-induced interstitial lung disease in Japanese rheumatoid arthritis patients: a multidrug hypersensitivity marker? Ann Rheum Dis. 2013;72(1):153-5. doi: 10.1136/annrheumdis-2012-201944
- Bluett J, Owen SA, Massey J, et al. HLA-A 31:01 is not associated with the development of methotrexate pneumonitis in the UK population: results from a genome-wide association study. Ann Rheum Dis. 2017;76(12):e51. doi: 10.1136/annrheumdis-2017-211512
- Jakubovic BD, Donovan A, Webster PM, Shear NH. Methotrexate-induced pulmonary toxicity. Can Respir J. 2013;20(3):153-5. doi: 10.1155/2013/527912
- Ohbayashi M, Suzuki M, Yashiro Y, et al. Induction of pulmonary fibrosis by methotrexate treatment in mice lung in vivo and in vitro. J Toxicol Sci. 2010;35(5):653-61. doi: 10.2131/jts.35.653
- Fragoulis GE, Nikiphorou E, Larsen J, et al. Methotrexate-Associated Pneumonitis and Rheumatoid Arthritis-Interstitial Lung Disease: Current Concepts for the Diagnosis and Treatment. Front Med (Lausanne). 2019;6:238. doi: 10.3389/fmed.2019.00238
- D’Elia T. Methotrexate-induced pneumonitis: heterogeneity of bronchoalveolar lavage and differences between cancer and rheumatoid arthritis. Inflamm Allergy Drug Targets. 2014;13(1):25-33. doi: 10.2174/1871528112666131230013059
Supplementary files
![](/img/style/loading.gif)