Balbir-Gurman Alexandra, Guralnik Ludmila, Best Lael-Anson, Vlodavsky Eugene, Yigla Mordehai, Menahem Nahir Abraham, Braun-Moscovici Yolanda
B. Shine Department of Rheumatology, Rambam Health Care Campus, Haifa, Israel.
J Clin Rheumatol. 2009 Feb;15(1):29-30. doi: 10.1097/RHU.0b013e31817de10b.
Pulmonary nodulosis and sterile pleural exudates are well-known extra-articular manifestations in rheumatoid arthritis patients with a positive rheumatoid factor. In some patients, treatment with methotrexate has been postulated as the trigger of these complications. We report a patient with psoriatic arthropathy, negative RF, negative anticyclic citrulinated peptide antibodies but positive antibodies to cardiolipin who developed massive sterile pleural empyema and multiple cavitary pulmonary nodules during methotrexate treatment. We suggest that awareness of methotrexate-induced lung and pleural complications should be extended to other than rheumatoid arthritis diseases, not necessarily accompanied by rheumatoid factor or anticyclic citrulinated peptide antibodies.
肺部结节病和无菌性胸腔积液是类风湿因子阳性的类风湿关节炎患者中众所周知的关节外表现。在一些患者中，甲氨蝶呤治疗被认为是这些并发症的触发因素。我们报告了一名银屑病关节炎患者，类风湿因子阴性，抗环瓜氨酸肽抗体阴性，但抗心磷脂抗体阳性，在甲氨蝶呤治疗期间出现大量无菌性胸腔积脓和多个空洞性肺结节。我们建议，对于甲氨蝶呤引起的肺部和胸膜并发症的认识应扩展到类风湿关节炎以外的其他疾病，这些疾病不一定伴有类风湿因子或抗环瓜氨酸肽抗体。
