Abstractrequires immediate discontinuation of the drug. 1 Characteristically, patients experience a Background -Pneumonitis is a rare but potentially life threatening side effect of prodromal phase with progressive cough, dyspnoea, and malaise which can last from a few methotrexate treatment for rheumatoid arthritis which needs to be distinguished days up to several weeks. At this stage incipient methotrexate pneumonitis needs to be disfrom interstitial lung disease due to rheumatoid arthritis.tinguished from interstitial lung disease due to rheumatoid arthritis. 1 This is usually made on Methods -To examine the value of bronchoalveolar lavage (BAL) in diag-clinical grounds such as the presence or absence of constitutional symptoms, the rate of pronosing methotrexate pneumonitis, the BAL cell profile of four patients with gression, and the response to withdrawal of the drug. While interstitial lung disease due to methotrexate pneumonitis was compared with findings in 16 patients with rheum-rheumatoid arthritis is usually a chronic disorder which takes a slowly progressive course atoid arthritis treated with methotrexate without clinical or radiological evidence and is associated with minor constitutional complaints, 2 methotrexate pneumonitis is an of lung disease and eight patients with interstitial lung disease secondary to acute and rapidly progressive disorder accompanied by prominent constitutional symprheumatoid arthritis treated with methotrexate.toms. monitis.Rheumaklinik Bad were diagnosed according to the criteria of (Thorax 1997;52:377-379) Pneumonitis is a potentially life threatening ology consistent with drug-induced injury. TheAccepted for publication 20 November 1996side effect of treatment with methotrexate that presence of any three of these criteria was
Sustained cough is a frequent complaint in methotrexate (MTX) treatment for rheumatoid arthritis and can be a symptom of incipient MTX-induced pneumonitis. This study was performed to characterize MTX-associated cough clinically and to clarify by which means this condition can be distinguished from incipient MTX pneumonitis. Three patients with MTX-induced pneumonitis and 10 patients with sustained cough unassociated with pneumonitis were examined clinically, by pulmonary function testing, and bronchoalveolar lavage (BAL). In MTX pneumonitis, cough was associated with progressive dyspnoea, constitutional symptoms, impaired pulmonary function, and interstitial infiltration of variable degree by chest X-ray. BAL cytology invariably showed lymphocytic alveolitis while transbronchial biopsy revealed active interstitial inflammation in only one patient. Ten patients had sustained, nonprogressive cough in the absence of constitutional symptoms, progressive dyspnoea and impaired pulmonary function. Neither X-ray nor BAL nor transbronchial biopsy revealed any evidence of interstitial lung disease. In the majority of these patients, cough abated with symptomatic treatment with or without temporary discontinuation of MTX. It is concluded that MTX-associated cough can be a reflection of isolated airway disease. Clinically, absence of constitutional symptoms, impaired pulmonary function, and interstitial infiltration on X-ray distinguished this condition from incipient MTX pneumonitis. Cough without pulmonary parenchymal involvement appears to result from an irritant effect of MTX on the airways.
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