PNEUMONITE POR METOTREXATO NA ARTRITE REUMATÓIDE: RELATO DE CASO
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Apr 13, 2022
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Cristhian Emilio Herrera Céspedes
https://orcid.org/0000-0003-3160-5881
Catalina González Avilés
https://orcid.org/0000-0002-1783-7769
Olga Milena García Morales
https://orcid.org/0000-0002-9921-883X
Pierangely Prieto Campos
https://orcid.org/0000-0003-3285-0715
https://orcid.org/0000-0003-3160-5881
Catalina González Avilés
https://orcid.org/0000-0002-1783-7769
Olga Milena García Morales
https://orcid.org/0000-0002-9921-883X
Pierangely Prieto Campos
https://orcid.org/0000-0003-3285-0715
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Resumo
O metotrexato (MTX) é um agente imunomodulador utilizado como modificador de doenças reumatológicas, pode ter efeitos tóxicos principalmente nos níveis hematológicos, cutâneos e de hipersensibilidade que incluem órgãos como o pulmão, na forma de pneumonites. Apresentamos o caso clínico de uma paciente de 51 anos com artrite reumatoide (AR), que apresentou pneumonite induzida por metotrexato com melhora subsequente do quadro clínico após a suspensão do medicamento e início da corticoterapia. Diferente do que se possa pensar, a pneumonite por metotrexato, por ser tão rara, deve ser considerada um diagnóstico de exclusão, dada a semelhança do quadro clínico com entidades mais comuns, como doenças pulmonares infecciosas e inflamatórias e doenças autoimunes.
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References
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2. Dawson JK, Graham DR, Desmond J, Fewins HE, Lynch MP. Investigation of the chronic pulmonary effects of low-dose oral methotrexate in patients with rheumatoid arthritis: a prospective study incorporating HRCT scanning and pulmonary function tests. Rheumatology (Oxford). 2002;41(3):262-7. https://pubmed.ncbi.nlm.nih.gov/11934961/
3. Imokawa S, Colby TV, Leslie KO, Helmers RA. Methotrexate pneumonitis: review of the literature and histopathological findings in nine patients. Eur Respir J. 2000;15(2):373-81. https://pubmed.ncbi.nlm.nih.gov/10706507/
4. Kiely P, Busby AD, Nikiphorou E, Sullivan K, Walsh DA, Creamer P, et al. Is incident rheumatoid arthritis interstitial lung disease associated with methotrexate treatment? Results from a multivariate analysis in the ERAS and ERAN inception cohorts. BMJ Open. 2019;9(5):e028466. https://pubmed.ncbi.nlm.nih.gov/31061059/
5. Juge PA, Lee JS, Lau J, Kawano L, Rojas-Serrano J, Sebastiani M, et al. Methotrexate and rheumatoid arthritis associated interstitial lung disease. Eur Respir J. 2021;57(2):2000337. https://pubmed.ncbi.nlm.nih.gov/32646919/
6. Ibfelt EH, Jacobsen RK, Kopp TI, Cordtz R, Jakobsen AS, Seersholm N, et al. Op0232 Treatment with Methotrexate and Risk of Lung Disease in Patients with Rheumatoid Arthritis: A Nationwide Population-Based Cohort Study from Denmark. Annals of the Rheumatic Diseases. 2020;79(Suppl 1):147-8. https://pubmed.ncbi.nlm.nih.gov/32780828/
7. Barrera P, Laan RF, van Riel PL, Dekhuijzen PN, Boerbooms AM, van de Putte LB. Methotrexate-related pulmonary complications in rheumatoid arthritis. Ann Rheum Dis. 1994;53(7):434-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1005365/
8. Fragoulis GE, Nikiphorou E, Larsen J, Korsten P, Conway R. Methotrexate-associated pneumonitis, and rheumatoid arthritis-interstitial lung disease: current concepts for the diagnosis and treatment. Front Med. 2019;6:238. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6819370/
9. Searles G, McKendry RJ. Methotrexate pneumonitis in rheumatoid arthritis: potential risk factors. Four case reports and a review of the literature. J Rheumatol. 1987;14(6):1164-71. https://pubmed.ncbi.nlm.nih.gov/3325643/
10. Kremer JM, Alarcón GS, Weinblatt ME, Kaymakcian MV, Macaluso M, Cannon GW, et al. Clinical, laboratory, radiographic, and histopathologic features of methotrexate-associated lung injury in patients with rheumatoid arthritis: a multicenter study with literature review. Arthritis Rheum. 1997;40(10):1829-37. https://pubmed.ncbi.nlm.nih.gov/9336418/
2. Dawson JK, Graham DR, Desmond J, Fewins HE, Lynch MP. Investigation of the chronic pulmonary effects of low-dose oral methotrexate in patients with rheumatoid arthritis: a prospective study incorporating HRCT scanning and pulmonary function tests. Rheumatology (Oxford). 2002;41(3):262-7. https://pubmed.ncbi.nlm.nih.gov/11934961/
3. Imokawa S, Colby TV, Leslie KO, Helmers RA. Methotrexate pneumonitis: review of the literature and histopathological findings in nine patients. Eur Respir J. 2000;15(2):373-81. https://pubmed.ncbi.nlm.nih.gov/10706507/
4. Kiely P, Busby AD, Nikiphorou E, Sullivan K, Walsh DA, Creamer P, et al. Is incident rheumatoid arthritis interstitial lung disease associated with methotrexate treatment? Results from a multivariate analysis in the ERAS and ERAN inception cohorts. BMJ Open. 2019;9(5):e028466. https://pubmed.ncbi.nlm.nih.gov/31061059/
5. Juge PA, Lee JS, Lau J, Kawano L, Rojas-Serrano J, Sebastiani M, et al. Methotrexate and rheumatoid arthritis associated interstitial lung disease. Eur Respir J. 2021;57(2):2000337. https://pubmed.ncbi.nlm.nih.gov/32646919/
6. Ibfelt EH, Jacobsen RK, Kopp TI, Cordtz R, Jakobsen AS, Seersholm N, et al. Op0232 Treatment with Methotrexate and Risk of Lung Disease in Patients with Rheumatoid Arthritis: A Nationwide Population-Based Cohort Study from Denmark. Annals of the Rheumatic Diseases. 2020;79(Suppl 1):147-8. https://pubmed.ncbi.nlm.nih.gov/32780828/
7. Barrera P, Laan RF, van Riel PL, Dekhuijzen PN, Boerbooms AM, van de Putte LB. Methotrexate-related pulmonary complications in rheumatoid arthritis. Ann Rheum Dis. 1994;53(7):434-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1005365/
8. Fragoulis GE, Nikiphorou E, Larsen J, Korsten P, Conway R. Methotrexate-associated pneumonitis, and rheumatoid arthritis-interstitial lung disease: current concepts for the diagnosis and treatment. Front Med. 2019;6:238. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6819370/
9. Searles G, McKendry RJ. Methotrexate pneumonitis in rheumatoid arthritis: potential risk factors. Four case reports and a review of the literature. J Rheumatol. 1987;14(6):1164-71. https://pubmed.ncbi.nlm.nih.gov/3325643/
10. Kremer JM, Alarcón GS, Weinblatt ME, Kaymakcian MV, Macaluso M, Cannon GW, et al. Clinical, laboratory, radiographic, and histopathologic features of methotrexate-associated lung injury in patients with rheumatoid arthritis: a multicenter study with literature review. Arthritis Rheum. 1997;40(10):1829-37. https://pubmed.ncbi.nlm.nih.gov/9336418/
Como Citar
Herrera Céspedes, C. E. ., González Avilés, C., García Morales, O. M. ., & Prieto Campos , P. (2022). PNEUMONITE POR METOTREXATO NA ARTRITE REUMATÓIDE: RELATO DE CASO. Universitas Medica, 63(2). https://doi.org/10.11144/Javeriana.umed63-2.nmar
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