Methotrexate‐based regimen as initial treatment of patients with idiopathic granulomatous mastitis

Haddad, Mahbubeh; Sheybani, Fereshte; Arian, Mahnaz; Gharib, Masoumeh

doi:10.1111/tbj.13590

Cited by 26 publications

(26 citation statements)

References 9 publications

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“…Twenty‐two studies were identified, 14 were excluded (nine case reports with fewer than three patients, three review articles, one without patient outcomes reported and one not written in English) 3,7,12,13,16‐19 . All studies were retrospective case series except for one, which was a prospective case series 3 .…”

Section: Resultsmentioning

confidence: 99%

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A rheumatologic approach to granulomatous mastitis: A case series and review of the literature

Ringsted

Friedman

2021

Int J of Rheum Dis

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Aim Idiopathic granulomatous mastitis (IGM) is an enigmatic inflammatory breast disorder. IGM responds to immunomodulatory treatment and may be associated with systemic manifestations such as arthritis and erythema nodosum. These patients are increasingly referred to rheumatologists for management, but IGM is rarely discussed in the rheumatology literature. The objective of this report is to familiarize rheumatologists with the treatment and systemic manifestations of IGM. We report here a case series of IGM at our institution, and a literature review of IGM treated with methotrexate (MTX). Method Patients with IGM at our institution were identified and described using a retrospective chart review. A literature review of PubMed and Google Scholar identified studies of IGM patients treated with MTX. Results We identified 28 IGM patients at our institution. Inflammatory arthritis/arthralgia were present in four patients (14%), and five patients (18%) had erythema nodosum. Patients treated with MTX had the highest rates of relapse‐free remission; relapse‐free remission occurred in four of the five (80%) MTX‐treated patients, compared with 5 of 12 (42%) patients treated with steroids alone, and two or three (66%) patients treated with steroids and surgery. In the literature review, 116 patients treated with MTX were identified, and the rate of relapse‐free remission ranged from 58% to 100%. Arthritis/arthralgia and erythema nodosum were more common at our institution than reported in the literature. Conclusion Methotrexate is a promising treatment for IGM. Arthritis/arthralgias and erythema nodosum may be under‐recognized when IGM patients are managed outside rheumatology. Prospective studies are needed to characterize clinical features and optimum treatment of IGM.

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Section: Resultsmentioning

confidence: 99%

“…The majority of patients had tried/failed other treatments including steroids, anti‐TB treatment, and/or surgery. One study used MTX as initial therapy 16 and in another, 7 out of the 12 patients received MTX as initial therapy 3 . Patients were treated with doses of MTX ranging from 7.5 to 25 mg weekly.…”

Section: Resultsmentioning

confidence: 99%

A rheumatologic approach to granulomatous mastitis: A case series and review of the literature

Ringsted

Friedman

2021

Int J of Rheum Dis

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“…In one study, the initial response rate observed with MTX alone and in combination with steroids was 100% however, 17.6% patients had a relapse on discontinuation of the treatment. Side effects associated with MTX are; hair loss, deranged liver functions and compliance 13,14 .…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Dilemma and Treatment Challenges in Idiopathic Granulomatous Mastitis

Latif

Naqvi

Bano

et al. 2021

PAFMJ

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Objective: To outline diagnostic difficulties and problems in the treatment of Idiopathic Granulomatous Mastitis Study Design: Prospective observational study. Place and Duration of Study: Breast clinic, Combined Military Hospital Rawalpindi, from Aug 2019 to Jul 2020. Methodology: Patients with tender mass with or without signs of inflammation, mass with abscess, sinus formation, and with recurrent abscesses were included. Those cases were labelled as IGM whose histopathology showed granulomatous mastitis with no evidence of malignancy and tissue cultures were negative. Patients with mild to moderate symptoms were treated with reassurance, analgesia and multivitamins. Abscesses were treated with incision & drainage and empirical antibiotics for 1-2 weeks. All these patients were followed at 1, 3, 6 and 12 months. Results: A total of 35 patients fulfilled the criteria for Idiopathic Granulomatous Mastitis and were included in the study. Two patients had lactational abscess, 3 had bilateral disease and 1 patient was with diabetes 0% patients were having mass with abscess; spontaneous resolution was observed in majority of them with a few requiring incision and drainage. Of 31.4% presented with tender mass only; majority of them resolved with observation, except mass excision in two patients, 19.7% presented with discharging sinuses with underlying mass; among them 71% responded to conservative treatment while 29% were treated with anti-tuberculous therapy for recurrent sinuses. 8.5% presented with spontaneously ruptured abscesses with sinuses; they were managed conservatively. Conclusion: We concluded that Idiopathic Granulomatous Mastitisis a benign self-limiting disease which can be effectively managed with conservative treatment.

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“…However, MTX can be initiated as a first-line therapy in patients with contraindications that use steroid therapy, but MTX therapy should be initiated at a dose of 5 mg/week and the side effect of the drug should be checked by routine blood tests. Briefly, only a few researchers suggest the use of MTX or MTX plus steroid as the first-line therapy; however, there is a consensus on the use of steroid therapy before initiating MTX [2,4].…”

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confidence: 99%

“…Long-term therapy of MTX and steroids for completely benign disease should be evaluated carefully due to its detrimental effects in patients with an age range of 20-40 years. Besides nearly 29-50% recurrence rates following steroids or MTX treatment result in questioning the necessity of steroids or MTX therapy in patients [4,5]. Therefore, one of the radical surgical treatment options (partial or total mastectomy-plus breast reconstruction) should be offered to reproductive aged-patients who have recurred IGM disease despite more than 2 cycles of steroid and MTX treatment.…”

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confidence: 99%

Comment on: “Treatment of idiopathic granulomatous mastitis and factors related with disease recurrence”

Akbulut¹,

Şahin²

2020

Turk J Med Sci

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We read the recent article "Treatment of idiopathic granulomatous mastitis and factors related with disease recurrence" published by Tekgoz and colleagues with great interest [1]. The authors stated that they aimed to investigate the effect of immunosuppressive treatment on idiopathic granulomatous mastitis (IGM) and risk factors related to IGM recurrence.We would like to emphasize a few important points regarding the medical management algorithm of the present study.The authors state that they have applied a cross-sectional retrospective research model in the present study. This statement is wrong in terms of epidemiological aspect because the studies that go from the outcome to the exposure are retrospective case-control studies. The cross-sectional studies evaluate the exposure and outcome at the same time and are usually performed to determine the prevalence of certain conditions or diseases. Other names of the study method are epidemiological surveillance, transvers study, screening, fact-findings survey, ad hoc survey, point-in-time study, and one-shot survey.The authors did not give any information regarding their management protocol to patients with IGM. In Turkey, the duration from admission to the histopathological diagnosis of IGM is around 3-4 weeks. In patients with abscess and cellulitis, it is not rational to wait for the biopsy result without performing drainage and/or antibiotics. The current literature suggests that drainage and antibiotics should be performed to patients admitted with abscess and cellulitis. Also, patients with inflammatory mass should receive antiinflammatory treatment after the biopsy until the definitive results are obtained. We would like to share our diagnostic and therapeutic algorithm that we have deduced from our own experiences and extensive review of the literature (Figure). We believe it will contribute to the present study and this extensive algorithm is first in the medical literature.

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Methotrexate‐based regimen as initial treatment of patients with idiopathic granulomatous mastitis

Cited by 26 publications

References 9 publications

A rheumatologic approach to granulomatous mastitis: A case series and review of the literature

A rheumatologic approach to granulomatous mastitis: A case series and review of the literature

Diagnostic Dilemma and Treatment Challenges in Idiopathic Granulomatous Mastitis

Comment on: “Treatment of idiopathic granulomatous mastitis and factors related with disease recurrence”

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