Clinical Rheumatology

, Volume 16, Issue 3, pp 296–304

Methotrexate-induced pneumonitis in patients with rheumatoid arthritis and psoriatic arthritis: Report of five cases and review of the literature

  • F. Salaffi
  • P. Manganelli
  • M. Carotti
  • S. Subiaco
  • G. Lamanna
  • C. Cervini
Originals

DOI: 10.1007/BF02238967

Cite this article as:
Salaffi, F., Manganelli, P., Carotti, M. et al. Clin Rheumatol (1997) 16: 296. doi:10.1007/BF02238967

Summary

Pneumonitis is emerging as one of the most unpredictable and potentially serious, adverse effects of treatment with MTX. Its prevalence in rheumatoid arthritis (RA) has been estimated from several retrospective and prospective studies to range from 0.3% to 18%. On the other hand, MTX-induced pneumonitis seems to be very rare in psoriatic arthritis (PsA).

Our review of 194 RA patients and 38 PsA patients receiving MTX has identified four RA patients and one PsA patient with MTX-induced pneumonitis, giving a prevalence of 2.1% and 0.03%, respectively. Diagnosis was suggested by clinical history and radiographic findings, but the bronchoalveolar lavage plays an important role both in excluding infectious agents and in providing information for understanding the pathogenesis of lung injury. The presence of a lymphocyte alveolitis with a predominance of CD4+ T cells in 3 RA patients and CD8+ T cells with a concomitant increase in neutrophils in another case suggests that immunologically mediated reactions may be one damage mechanism in MTX-induced pneumonitis. Although risk factors for MTX-induced pulmonary toxicity are poorly understood, the presence in 3 out of 5 of our patients of pre-existing lung disease, represented by diffuse interstitial changes on chest X-ray, and mild bronchial asthma in two RA patients and by pulmonary silicosis in the patient with PsA may account for a predisposition to the development of MTX pneumonitis.

Key words

Methotrexate Pneumonitis Rheumatoid Arthritis Psoriatic Arthritis Bronchoalveolar Lavage 

Copyright information

© Clinical Rheumatology 1997

Authors and Affiliations

  • F. Salaffi
    • 4
  • P. Manganelli
    • 1
  • M. Carotti
    • 2
  • S. Subiaco
    • 3
  • G. Lamanna
    • 4
  • C. Cervini
    • 4
  1. 1.II Divisione Medica e Reumatologia, Azienda Ospedaliera di ParmaItaly
  2. 2.Cattedra di RadiologiaUniversità di AnconaItaly
  3. 3.Divisione di Broncopneumologia — Azienda Ospedaliera di Jesi (Ancona) — USL 5Italy
  4. 4.Clinica ReumatologicaUniversità di AnconaJesi (Ancona)Italy

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