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A Journal on Internal Medicine

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Panminerva Medica 2016 Oct 06

language: English

Methotrexate and lung disease in rheumatoid arthritis

Richard CONWAY 1, 2, John J. CAREY 3, 4

1 Centre for Arthritis and Rheumatic Diseases, St Vincent’s University Hospital, Dublin Academic Medical Centre, Elm Park, Dublin, Ireland; 2 CARD Newman Research Fellow, University College Dublin, Belfield, Dublin, Ireland; 3 Department of Rheumatology, Galway University Hospitals, Merlin Park, Galway, Ireland; 4 Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland


Rheumatoid arthritis (RA) is a common chronic inflammatory disease affecting many tissues and resulting in substantial morbidity and increased mortality. Arthritis is the most notable clinical feature, but extra-articular features can have devastating consequences. Pulmonary manifestations are common in RA, with high rates of disease related lung disease and a propensity to pulmonary infections. Respiratory illness remains a leading cause of death among RA populations. Modern medicine greatly reduces the illness burden among patients with RA, particularly through the use of disease-modifying medications. Methotrexate is recommended as the first-line treatment of RA as it effectively reduces disease activity, morbidity and mortality. However it has long been implicated as a causative agent in lung disease. The evidence for a cause and effect relationship in modern populations is contentious, but critically important. Increasing recognition of the importance and prevalence of interstitial lung disease in RA, and recent studies on the incidence of lung disease among RA and non-RA populations have cast doubt on the role of methotrexate as a causative agent. A correct understanding of the complex pulmonary disease processes in RA is crucial if we are to improve outcomes in this patient group. In this article we will discuss the epidemiology and characteristics of lung disease in rheumatoid arthritis and its possible relationship to methotrexate use.

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