Rheumatology Advance Access originally published online on August 15, 2003
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Rheumatology 2004; 43: 143-147
© British Society for Rheumatology 2003; all rights reserved
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Reducing the risk of methotrexate pneumonitis in rheumatoid arthritis
1Department of Rheumatology, Freeman Hospital, Newcastle-upon-Tyne and 2Department of Medicine and Rheumatology, Queen Elizabeth Hospital, Gateshead, UK.
Correspondence to: V. Saravanan, Department of Rheumatology, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK. E-mail: saravana_uk@yahoo.co.uk
| The first 150 words of the full text of this article appear below. |
Methotrexate (MTX) is the most commonly used disease-modifying drug (DMARD) in rheumatoid arthritis (RA) [1]. It is a main anchor drug in many combination regimes with conventional DMARDs and biological agents. It has the longest drug-survival time and a good benefit/toxicity ratio [2, 3]. However, toxicity is a major reason for MTX withdrawal in RA [3]. Pneumonitis is the reason for withdrawal of MTX in 1 in 108 patient-years compared with 1 in 35 patient-years for hepatic toxicity and 1 in 58 patient-years for neutropenia [3]. There are guidelines for effective monitoring of the hepatic and haematological toxicity of MTX [4, 5]. Pneumonitis following MTX is a potentially fatal hypersensitivity reaction and is far less predictable than hepatic and haematological toxicity. Current guidelines [4, 5] advise a pretreatment chest radiograph (CXR), though there are wide
Prevalence and pathogenesis of methotrexate pneumonitis
Risk factors
Clinical features
Investigations
Treatment
Prognosis
Chronic effects of MTX
Which RA patients should be given methotrexate?
What baseline tests are useful prior to methotrexate?
Proposal
Conflict of interest
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