1例类风湿关节炎患者在低剂量每周一次甲氨蝶呤治疗期间出现类风湿性胸膜炎加速进展。

A case of rheumatoid arthritis exhibiting accelerating rheumatoid pleurisy during low-dose weekly methotrexate therapy.

作者信息

Kato Takashi, Ubara Yoshifumi, Sawa Naoki, Tagami Tetsuo, Katori Hideyuki, Takemoto Fumi, Tanimoto Akihide, Takaichi Kenmei

机构信息

Kidney Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan.

出版信息

Mod Rheumatol. 2004;14(5):414-8. doi: 10.1007/s10165-004-0337-y.

DOI:10.1007/s10165-004-0337-y

PMID:17143704

Abstract

A 75-year-old Japanese man suffering from rheumatoid arthritis (RA) had received methotrexate (MTX) treatment for 9 years and developed bilateral pleural thickening with exudative pleural effusions despite remission of the polyarthritis. A diagnosis of rheumatoid pleurisy, made by exclusion, was supported by the elevated rheumatoid factor level of the pleural fluid. The pleurisy developed concomitantly with MTX-induced leukocytopenia, and discontinuation of the MTX treatment partially improved the CRP level. These findings indicate a causal relation between the rheumatoid pleurisy and MTX and suggest that MTX therapy may be ineffective in the treatment of rheumatoid pleurisy. Treatment with 10 mg of prednisolone and 100 mg of cyclosporine A daily resulted in rapid resolution of the pleurisy. Although MTX-induced rheumatoid pleurisy is a rare condition, MTX therapy should be considered carefully in RA patients with concomitant rheumatoid pleurisy.

摘要

一名75岁的日本男性患有类风湿关节炎（RA），接受甲氨蝶呤（MTX）治疗9年，尽管多关节炎已缓解，但仍出现双侧胸膜增厚并伴有渗出性胸腔积液。通过排除法诊断为类风湿性胸膜炎，胸水类风湿因子水平升高支持该诊断。胸膜炎与MTX诱导的白细胞减少同时发生，停用MTX治疗后CRP水平部分改善。这些发现表明类风湿性胸膜炎与MTX之间存在因果关系，并提示MTX治疗可能对类风湿性胸膜炎无效。每日服用10 mg泼尼松龙和100 mg环孢素A治疗可使胸膜炎迅速消退。虽然MTX诱导的类风湿性胸膜炎是一种罕见情况，但对于合并类风湿性胸膜炎的RA患者，应谨慎考虑MTX治疗。