Barral Juez I, Pérez Fernández N, Lombera Sáez L, Salegi Etxebeste I
Hospital Universitario Donostia. Donostia-San Sebastián. Gipuzkoa (España)
Rev. OFIL 2016, 26;2:131-133
Fecha de recepción: 20/07/2015 – Fecha de aceptación: 21/12/2015
Pulmonary toxicity methotrexate is an acute and severe complication that is characterized by the appearance of dry cough, dyspnea and fever, with a radiological pattern of interstitial infiltrate. Although pulmonary toxicity associated with methotrexate is rare, it has been estimated incidence of 3.9% and 5.5% prevalence of patients/year exposed to MTX, and although it appears much more frequently in case of treatment of rheumatoid arthritis (RA) in psoriatic arthritis (PA), also referred in psoriatic patients. The pathogenesis is not well defined, findings suggest that inflammation in MTX-induced lung injury occurs via the MAPK pathway. Recognized risk factors include advanced age, diabetes mellitus, hypoalbuminemia and extra articular manifestations, especially pulmonary rheumatoid arthritis. Treatment with high-dose corticosteroids and respiratory support measures favoring the complete clinical resolution, although mortality reaches 20% in some groups. Pulmonary prognosis of patients in excess pneumonitis is good with a complete radiological and functional recovery in most.
Key Words: Pulmonary toxicity, pulmonary fibrosis, methotrexate, drug toxicity.