1. MTX Lung vs. Rheumatoid Lung Disease
MTX Hypersensitivity Pneumonitis
Rheumatoid Lung
Distiguishing Features
Early after MTX use
Long-Standing RA
RF+ or RF-
Strongly Seropositive
Usually without Deformity
Deformities, Nodules, & Extraarticular Sxs
BAL: Lymphocytes
BAL: Neutrophils
Steroid Responsive
No Steroid Response
Very Good Prognosis
Poor 10 yr. Survival
2013 Sep 13;3(9):e doi: /bmjopen
Acute exacerbation in rheumatoid arthritis-associated interstitial lung disease: a retrospective case control study.
Hozumi H, Nakamura Y, Johkoh T, Sumikawa H, Colby TV, Kono M, Hashimoto D, Enomoto N, Fujisawa T, Inui N, Suda T, Chida K.
Author information
Abstract
OBJECTIVES:
To investigate the risk factors and prognosis associated with acute exacerbation (AE) in patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD).
DESIGN:
A retrospective case-control study.
SETTING:
A single academic hospital.
PARTICIPANTS:
51 consecutive patients diagnosed with RA-ILD between 1995 and All patients fulfilled the diagnostic criteria of the American College of Rheumatology for RA. ILD was diagnosed on the basis of clinical presentation, pulmonary function tests, high-resolution CT (HRCT) findings and lung biopsy findings.
MAIN OUTCOME MEASURES:
Overall survival and cumulative AE incidence were analysed using Kaplan-Meier method. Cox hazards analysis was used to determine significant variables associated with AE occurrence and survival status.
RESULTS:
A total of 11 patients (22%) developed AE, with an overall 1-year incidence of 2.8%. Univariate analysis revealed that older age at ILD diagnosis (HR 1.11; 95% CI 1.02 to 1.21; p=0.01), usual interstitial pneumonia (UIP) pattern on HRCT (HR 1.95; 95% CI 1.07 to 3.63; p=0.03) and methotrexate usage (HR 3.04; 95% CI 1.62 to 6.02; p=0.001) were associated with AE. Of 11 patients who developed AE during observation period, 7 (64%) died of initial AE. In survival, AE was a prognostic factor for poor outcome (HR 2.47; 95% CI 1.39 to 4.56; p=0.003).
CONCLUSIONS: In patients with RA-ILD, older age at ILD diagnosis, UIP pattern on HRCT and methotrexate usage are associated with the development of AE. Furthermore, AE has a serious impact on their survival.
KEYWORDS:
Rheumatology
Arthritis Rheum Dec 24. doi: /art [Epub ahead of print]
Methotrexate and lung disease in rheumatoid arthritis - A meta-analysis of randomized controlled trials.
Conway R, Low C, Coughlan RJ, O'Donnell MJ, Carey JJ.
Objective Methotrexate has shown efficacy in treating several diseases, especially rheumatoid arthritis (RA). Methotrexate has 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 infections. The aim of this study was to evaluate the relative risk of pulmonary disease among RA patients treated with methotrexate. Methods We searched Pubmed and Cochrane databases between 1st January 1990 and 1st February 2013 for double-blind randomised controlled trials of methotrexate versus placebo or active comparator agents in adults with RA. Studies with less than 100 subjects or of less than 24 weeks duration were excluded. Two investigators independently searched both databases. All authors reviewed selected studies. We compared relative risk (RR) differences using the Mantel-Haenszel random effects method. Results A total of 22 studies with 8584 participants met our inclusion criteria. Heterogeneity across the studies was not significant (I2 =3%), allowing combination of trial results. Methotrexate was associated with an increased risk of all adverse respiratory events, RR 1.10(CI ), and respiratory infections, RR 1.11(CI ). Patients treated with methotrexate were not at increased risk of pulmonary death, RR 1.53(CI ), or non-infectious respiratory events, RR 1.02(CI ). A subgroup analysis of studies reporting pneumonitis revealed an increased risk with methotrexate, RR 7.81(CI ). Conclusion Our study found a small but significant increase in the risk of lung disease in RA patients treated with methotrexate compared to other disease-modifying antirheumatic drugs and biologic agents. © 2013 American College of Rheumatology.
Copyright © 2013 American College of Rheumatology.
PMID:
*BAL: bronchoalveolar lavage
Dawson Rheumatology2002;41:597; Salaffi F, Clin Rheumatol. 1997;16: