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Certain therapies linked to pulmonary toxicity among patients with rheumatic diseases
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CHICAGO - About 13% of patients with rheumatic diseases have interstitial lung disease, and pulmonary toxicity is associated with certain rheumatic therapies, including methotrexate, according to information presented at the American College of Rheumatology State-of-the-Art Clinical Symposium, here.
Kristin Highland, MD, who is trained in both rheumatology and pulmonary/critical care, presented data from Pneumotox, an online drug-induced respiratory disease database, on the pulmonary toxicity risks of certain drugs used to treat rheumatic diseases.
Methotrexate is well-known for its potential risk for toxicity, according to Highland. Risk factors include increasing age, diabetes, existing lung disease, renal disease and previous use of disease-modifying anti-rheumatic drugs (DMARDs).
Most cases of pneumotoxicity occur early in treatment, typically within 1 year of therapy, and the incidence is variable, between 0.3% and 0.8%, she said. As an example, Highland described a large meta-analysis that included 21 studies and more than 8,000 patients with rheumatoid arthritis (RA), which showed no increased risk for additional pulmonary events or pulmonary death as a result of methotrexate therapy; however, an increased risk for developing methotrexate rhinitis was observed. No cases were reported after 2001, she said.
The most common presentations of methotrexate-induced pulmonary toxicity are dyspnea, fever and non-productive cough, according to Highland, who added that infection must be ruled out before diagnosis of methotrexate rhinitis.
A restrictive ventilatory defect is usually present, Highland said, and on chest X-rays, diffuse interstitial infiltrates and patchy infiltrates may also be seen.
Methotrexate rhinitis can progress to respiratory failure, according to Highland. Treatment consists of drug cessation, and a fairly favorable prognosis is likely, but chronic lung disease can develop.
Highland encouraged physicians to visit the Pneumotox database to learn more about the pulmonary toxicity risks of these and other medications. - by Shirley Pulawski
Reference:
Highland K. Session IV, presentation #3. Presented at: American College of Rheumatology State-of-the-Art Clinical Symposium. May 2-3, 2015; Chicago.
Disclosure: Highland reports no relevant financial disclosures.