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Clinical, laboratory, radiographic, and histopathologic features of methotrexate-associated lung injury in patients with rheumatoid arthritis: a multicenter study with literature review.

Publication ,  Journal Article
Kremer, JM; Alarcón, GS; Weinblatt, ME; Kaymakcian, MV; Macaluso, M; Cannon, GW; Palmer, WR; Sundy, JS; St Clair, EW; Alexander, RW; Smith, GJ ...
Published in: Arthritis Rheum
October 1997

OBJECTIVE: To describe the clinical, laboratory, radiologic, and histopathologic features of methotrexate (MTX)-induced lung injury in a combined cohort of selected patients with rheumatoid arthritis (RA) and all cases reported in the English-language literature. METHODS: Retrospective combined cohort review and abstraction from the medical literature. Case reports were obtained from 6 centers that had 4 or more cases of potential MTX lung injury per site. RA patients who were seen between 1981 and 1993 and who satisfied predetermined criteria for the presence of MTX lung injury were identified. RESULTS: Twenty-seven patients satisfied the criteria for definite MTX lung injury, and 2 for probable MTX lung injury. Predominant clinical features of MTX lung injury included shortness of breath in 27 patients (93.1%), which was present for 23.5 +/- 22.3 days (mean +/- SD), cough in 24 (82.8%), present for 26.9 +/- 28.5 days, and fever in 20 (69.0%), present for 10.4 +/- 12.8 days. Five patients (17.2%) died, compared with 12 of 68 (17.6%) reported in the medical literature. Four of the 6 patients who were re-treated with MTX after an initial pulmonary event developed recurrent lung toxicity, resulting in 2 deaths, compared with a recurrence rate of 3 of 6 in the literature. CONCLUSION: MTX lung injury is most often a subacute process, in which symptoms are commonly present for several weeks before diagnosis. Approximately 50% of the cases are diagnosed within 32 weeks from initiation of MTX treatment. A patient who recovers from MTX lung injury should not be re-treated. Earlier recognition and drug withdrawal may avoid the serious and sometimes fatal outcome that has been observed in this and other studies.

Duke Scholars

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Published In

Arthritis Rheum

DOI

ISSN

0004-3591

Publication Date

October 1997

Volume

40

Issue

10

Start / End Page

1829 / 1837

Location

United States

Related Subject Headings

  • Radiography
  • Middle Aged
  • Methotrexate
  • Male
  • Lung Diseases
  • Lung
  • Humans
  • Female
  • Cohort Studies
  • Arthritis, Rheumatoid
 

Citation

APA
Chicago
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MLA
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Kremer, J. M., Alarcón, G. S., Weinblatt, M. E., Kaymakcian, M. V., Macaluso, M., Cannon, G. W., … Axiotis, C. A. (1997). Clinical, laboratory, radiographic, and histopathologic features of methotrexate-associated lung injury in patients with rheumatoid arthritis: a multicenter study with literature review. Arthritis Rheum, 40(10), 1829–1837. https://doi.org/10.1002/art.1780401016
Kremer, J. M., G. S. Alarcón, M. E. Weinblatt, M. V. Kaymakcian, M. Macaluso, G. W. Cannon, W. R. Palmer, et al. “Clinical, laboratory, radiographic, and histopathologic features of methotrexate-associated lung injury in patients with rheumatoid arthritis: a multicenter study with literature review.Arthritis Rheum 40, no. 10 (October 1997): 1829–37. https://doi.org/10.1002/art.1780401016.
Kremer JM, Alarcón GS, Weinblatt ME, Kaymakcian MV, Macaluso M, Cannon GW, et al. Clinical, laboratory, radiographic, and histopathologic features of methotrexate-associated lung injury in patients with rheumatoid arthritis: a multicenter study with literature review. Arthritis Rheum. 1997 Oct;40(10):1829–37.
Kremer, J. M., et al. “Clinical, laboratory, radiographic, and histopathologic features of methotrexate-associated lung injury in patients with rheumatoid arthritis: a multicenter study with literature review.Arthritis Rheum, vol. 40, no. 10, Oct. 1997, pp. 1829–37. Pubmed, doi:10.1002/art.1780401016.
Kremer JM, Alarcón GS, Weinblatt ME, Kaymakcian MV, Macaluso M, Cannon GW, Palmer WR, Sundy JS, St Clair EW, Alexander RW, Smith GJ, Axiotis CA. Clinical, laboratory, radiographic, and histopathologic features of methotrexate-associated lung injury in patients with rheumatoid arthritis: a multicenter study with literature review. Arthritis Rheum. 1997 Oct;40(10):1829–1837.
Journal cover image

Published In

Arthritis Rheum

DOI

ISSN

0004-3591

Publication Date

October 1997

Volume

40

Issue

10

Start / End Page

1829 / 1837

Location

United States

Related Subject Headings

  • Radiography
  • Middle Aged
  • Methotrexate
  • Male
  • Lung Diseases
  • Lung
  • Humans
  • Female
  • Cohort Studies
  • Arthritis, Rheumatoid