Methotrexate-related pulmonary complications in rheumatoid arthritis.

Abstract

Methotrexate (MTX) was described as a drug in 1946' and first used in the treatment of human disease (childhood leukaemia) in 1948.2 Successful MTX treatment for rheumatoid arthritis (RA) and psoriasis was reported in 1951,3 although the interest in this drug at that time was probably overshadowed by the impressive results of cortico-steroid treatment until approximately 1980. MTX was approved by the food and drug administration (FDA) for the treatment of severe and disabling psoriasis in 1971 and for RA only in 1988.4 MTX-related pulmonary toxicity was first observed during treatment of childhood leukaemia in 19695 and later in malignancies, psoriasis6 7 and polymyositis.7 I Though it was postulated that pulmonary toxicity would appear only with a weekly dose higher than 20 mg,7 this did not prove to be true when in 1983 pneumonitis was also reported during low-dose MTX treatment for RA9 10