OCCURRENCE OF PULMONARY COMPLICATIONS DURING METHOTREXATE THERAPY IN RHEUMATOID-ARTHRITIS

Treatment with methotrexate (MTX) in rheumatoid arthritis (RA) can lea d to severe side-effects, especially pulmonary and haematological comp lications. The aim of this retrospective study was to evaluate, during a 6 yr period, the prevalence and severity of bronchopulmonary side-e ffects in RA patients treated with MTX. A cohort of 130 RA in-patients (106 women, 24 men) treated with MTX was studied for the occurrence o f respiratory adverse events. Adverse bronchopulmonary side-effects we re observed in 12 patients (two men, 10 women), with a mean disease du ration of 15 yr. Only three patients had previously suffered from pulm onary disease. MTX treatment duration was between 1 month and 4.5 yr. The diagnosis was that of hypersensitivity pneumonitis (HSP) in four c ases. non-HSP pneumonitis in five patients with one case of Pneumocyst is carinii infection, and bronchitis in three cases. The initial respi ratory symptoms were not discriminatory between the different conditio ns. Risk factors were not identified for the occurrence of HSP. HSP al ways occurred in the first 5 months of treatment. Two patients with HS P died, and another patient with opportunistic infection underwent tra cheostomy. HSP represents a potentially lethal side-effect in RA patie nts treated with MTX. Improved education of patients and physicians sh ould certainly lead to a reduction of both the prevalence and severity of pulmonary side-effects during MTX therapy in RA.