Pneumonitis complicating low-dose methotrexate therapy in rheumatoid arthritis.
Pneumonitis complicating low-dose methotrexate therapy in rheumatoid arthritis.
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类风湿关节炎低剂量甲氨蝶呤治疗并发肺炎。
DOI：
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发表时间：
1985
影响因子：
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通讯作者：
R. Snyderman
中科院分区：
文献类型：
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作者：
E. Clair;J. Rice;R. Snyderman
在95名接受低剂量(5-15 mg/wk)甲氨蝶呤治疗的类风湿性关节炎患者中，有3名患者出现了甲氨蝶呤相关性肺损伤的临床、放射学和病理特征。显著的低氧血症强调了患者病情的严重性；每个患者的最低氧压值分别为35 mm Hg、42 mm Hg和45 mm Hg。我们对甲氨蝶呤出现肺部中毒反应的患者的处理包括停止药物治疗、抗生素治疗直到感染原因被排除，以及大剂量甲基强的松龙。两名患者康复，一名患者死亡。与早些时候的一份报告显示，只有在甲氨蝶呤剂量超过15毫克/周时才会发生肺炎，我们的三个病例表明，严重的肺部毒性反应也可能使每周小剂量甲氨蝶呤治疗类风湿关节炎复杂化。
Three of 95 patients with rheumatoid arthritis who were being treated with low-dose (5 to 15 mg/wk) methotrexate sodium developed the clinical, radiographic, and pathologic features of methotrexate-associated pulmonary injury. Marked hypoxemia emphasized the severity of illness in our patients; lowest oxygen pressure values for each patient were 35 mm Hg, 42 mm Hg, and 45 mm Hg. The management of our patients with a pulmonary toxic reaction to methotrexate included discontinuing the drug treatment, antibiotic therapy until an infectious cause was excluded, and high-dose methylprednisolone. Two patients recovered and one died. Contrary to an earlier report that suggested that pneumonitis occurred only with methotrexate sodium doses exceeding 15 mg/wk, our three cases demonstrate that a severe pulmonary toxic reaction may also complicate low-dose weekly methotrexate therapy of rheumatoid arthritis.