PERIPHERAL AND CAVITARY PULMONARY NODULOS IS IN A METHOTREXATE-TREATED RHEUMATOID-ARTHRITIS PATIENT

A 52-year-old man with a 3-year history of rheumatoid arthritis was tr eated in the past with parenteral gold, which failed to control the pa tient's symptoms. Treatment with weekly 7,5 mg methotrexate (MTX) was initiated in April 1990 and led to considerable clinical improvement. He was seen regularly in follow-up and experienced first rheumatoid no dules in July 1990 at the right elbow in the following months at the s ame place on the left side, on both hands and in both gluteal regions. Because of severe pain during prolonged sitting two nodules at the is chial tuberosities were excised in July 1993 and showed the typical hi stology of rheumatoid nodules. In October 1994 a chest radiograph was obtained in order to rule out rib fractures after trauma. It revealed a density of 4 cm diameter with a central cavity in the right lower lo be and two minor densities in the right middle lobe. All three of them were removed by thoracotomy and proved histologically to be rheumatoi d nodules, too. It is discussed, whether those and other MTX-related p ulmonary complications justify for repeated routine chest radiographs during long term MTX treatment of rheumatoid arthritis.