Periphere und einschmelzende pulmonale Rheumaknoten bei rheumatoider Arthritis unter Methotrexat-Therapie

Abstract

A 52-year-old man with a 3-year history of rheumatoid arthritis was treated in the past with parenteral gold, which failed to control the patient's symptoms. Treatment with weekly 7,5 mg methotrexate (MTX) was initiated in April 1990 and led to considerable clinical improvement. He was seen regularly in follow-up and experienced first rheumatoid nodules in July 1990 at the right elbow, in the following months at the same place on the left side, on both hands and in both gluteal regions. Because of severe pain during prolonged sitting two nodules at the ischial tuberosities were excised in July 1993 and showed the typical histology of rheumatoid nodules. In October 1994 a chest radiograph was obtained in order to rule out rib fractures after trauma. It revealed a density of 4 cm diameter with a central cavity in the right lower lobe and two minor densities in the right middle lobe. All three of them were removed by thoracotomy and proved histologically to be rheumatoid nodules, too. It is discussed, whether those and other MTX-related pulmonary complications justify for repeated routine chest radiographs during long term MTX treatment of rheumatoid arthritis.