TY - JOUR
TI - Methotrexate and interstitial lung disease: Controversies and questions. A narrative review of the literature
AU - Fragoulis, G.E.
AU - Conway, R.
AU - Nikiphorou, E.
JO - Rheumatology (United Kingdom)
PY - 2019
VL - 58
TODO - 11
SP - 1900-1906
PB - Oxford University Press
SN - null
TODO - 10.1093/rheumatology/kez337
TODO - methotrexate;  antirheumatic agent;  methotrexate, cardiovascular inflammation;  human;  interstitial lung disease;  lung disease;  meta analysis;  pneumonia;  priority journal;  randomized controlled trial (topic);  Review;  rheumatoid arthritis;  systematic review;  clinical trial (topic);  interstitial lung disease;  observational study;  pneumonia;  rheumatoid arthritis, Antirheumatic Agents;  Arthritis, Rheumatoid;  Clinical Trials as Topic;  Humans;  Lung Diseases, Interstitial;  Methotrexate;  Observational Studies as Topic;  Pneumonia
TODO - MTX, which is the anchor-drug for the treatment of RA, has been associated with lung injury and in particular with MTX-related pneumonitis (M-pneu). Although the frequency of M-pneu has been reported to range between 0.3 and 11.6%, more recent studies and meta-analyses have challenged that, suggesting that it is less common than previously thought. M-pneu is considered a hypersensitivity reaction usually occuring early after MTX commencement, and to be dose-independent. Furthermore, it does not seem to be truly related to the development of interstitial lung disease observed in some patients as part of the natural history of RA (RA-ILD). On the other hand, there are data suggesting that clinicians should be cautious when commencing MTX in patients with pre-existing lung disease. However, treatment should not be delayed or limited in progressive RA that could lead to RA-ILD, and MTX remains one of the central players in the treat-to-target approach. In this review, we aimed to summarize the current evidence from observational studies and clinical trials on lung disease in MTX-treated RA patients. We focus the discussion on the lack of association between M-pneu and RA-ILD. © 2019 The Author(s).
ER -