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Wednesday, October 1, 2014
Prognosis of methotrexate induced lung injury
What is the average life expectancy of patients diagnosed with Methotrexate lung injury/toxicity from Rheumatoid arthritis after initial onset and diagnosis? Does this disease have stages like cancer (I-IV)? If so, what are the signs and symptoms of end stage disease?
Methotrexate can cause a number of lung diseases and the prognosis depends on the type of problem and its severity. Because it lowers the immune system, the most common complication is probably infections. Pulmonary lymphoma has also been associated with methotrexate use - usually in patients with organ transplants. What is usually described as pulmonary toxicity associated with methotrexate can be acute (over several weeks), subacute (within months) and chronic (over years). The majority who develop problems do so in the first year of treatment. Risk factors for lung toxicity include age older than 60 years, rheumatoid lung disease, prior use of anti-rheumatoid drugs, low blood albumin level, diabetes, higher doses of Methotrexate, daily methotrexate instead of weekly, prior lung disease, and some concomitant medications. Nothing is absolutely diagnostic that methotrexate is causing the lung problems and it can cause similar problems to what rheumatoid arthritis can do to the lungs. This makes making this diagnosis tricky. There is no staging system of which I am aware. Most patients recover from methotrexate lung damage after discontinuing the methotrexate. Sometimes we also use steroids (like prednisone). However, about 1% of patients die from the syndrome and more have some continuing lung problems. End-stage disease would be characterized by severe shortness of breath, exercise intolerance, low oxygen levels, and severe changes on pulmonary function testing.
James M O'Brien, Jr, MD
Former Associate Professor
Pulmonary and Critical Care Medicine
College of Medicine
The Ohio State University