Thaniyan Anthony, Ayman Foad F A, Mirghani Hyder O, Al-Sayed Badr A, Merghani Tarig H
Department of Pharmacology, Faculty of Medicine, University of Tabuk, Saudi Arabia.
Department of Pathology, Faculty of Medicine, University of Tabuk, Saudi Arabia.
Open Access Maced J Med Sci. 2017 Apr 8;5(2):266-270. doi: 10.3889/oamjms.2017.049. eCollection 2017 Apr 15.
Methotrexate (MTX) is the most commonly used disease-modifying drug in the treatment of rheumatoid arthritis (RA); however, it causes many side effects, including pulmonary lesions. In this review, we characterised the histopathological features of MTX-induced pulmonary lesions in RA patients.
We carried out an electronic search of the relevant literature published during the period from 1990 to 2016. We included only the cases with definitive histo-pathological findings caused by MTX therapy.
The total number of cases is 27. Male: female ratio was 1:3, and ages ranged from 48 to 87 years old, with a mean (SD) = 65.7 (1.0). The cases were originally from Asia (55%), Europe (41%), and America (4%). The major complications of methotrexate therapy were lymphoproliferative disorders (42%) followed by interstitial fibrosis (33), and infections (25%). The incidence of these complications significantly increases with the duration of MTX treatment (p = 0.044). Among the infections, the most common causative organism was pneumocystis jiroveci. The majority of patients who developed infections following methotrexate therapy were from Europe whereas the majority of those who developed lymphoproliferative disorders were from Asia (p = 0.003).
In conclusion, methotrexate therapy in rheumatoid arthritis patients causes different types pulmonary complications.
甲氨蝶呤（MTX）是治疗类风湿关节炎（RA）最常用的改善病情药物；然而，它会引起许多副作用，包括肺部病变。在本综述中，我们描述了RA患者中MTX诱导的肺部病变的组织病理学特征。
我们对1990年至2016年期间发表的相关文献进行了电子检索。我们仅纳入了由MTX治疗引起的具有明确组织病理学结果的病例。
病例总数为27例。男女比例为1:3，年龄范围为48至87岁，平均（标准差）=65.7（1.0）。这些病例最初来自亚洲（55%）、欧洲（41%）和美洲（4%）。甲氨蝶呤治疗的主要并发症是淋巴增殖性疾病（42%），其次是间质性纤维化（33%）和感染（25%）。这些并发症的发生率随着MTX治疗时间的延长而显著增加（p = 0.044）。在感染中，最常见的病原体是耶氏肺孢子菌。接受甲氨蝶呤治疗后发生感染的大多数患者来自欧洲，而发生淋巴增殖性疾病的大多数患者来自亚洲（p = 0.003）。
总之，类风湿关节炎患者接受甲氨蝶呤治疗会导致不同类型的肺部并发症。
