NON-CELIAC SPRUE POSSIBLY RELATED TO METHOTREXATE IN A RHEUMATOID-ARTHRITIS PATIENT

We describe a case of non-coeliac sprue in a low-dose methotrexate tre ated patient suffering from rheumatoid arthritis. This is the first ca se report of this possibly reversible complication of methotrexate the rapy. The diagnosis was confirmed by a duodenal mucosal biopsy reveali ng the characteristic intestinal histopathology of coeliac sprue. Afte r discontinuation of the drug a repeat biopsy was almost normal, and c ompletely normal after reintroduction of a normal diet. One could spec ulate about the methotrexate related mechanism of the villous atrophy: it might be either a direct toxic effect or a secondary effect of the immunosuppression.