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The case of methotrexate and the lung: Dr Jekyll and Mr Hyde

Vincent Cottin, Elisabeth Bendstrup, Philippe Bonniaud, Mouhamad Nasser, Paolo Spagnolo, Claudia Valenzuela, Martin Kolb
European Respiratory Journal 2021 57: 2100079; DOI: 10.1183/13993003.00079-2021
Vincent Cottin
1Dept of Respiratory Medicine, National Coordinating Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
2University of Lyon, INRAE, IVPC, Lyon, France
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Elisabeth Bendstrup
3Center for Rare Lung Diseases, Dept of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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Philippe Bonniaud
4Constitutive Reference Center for Rare Pulmonary Diseases, Dept of Pulmonary Medicine and Intensive Care Unit, University Hospital, Bourgogne-Franche-Comté, Burgundy University, Inserm 1231, Dijon, France
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Mouhamad Nasser
1Dept of Respiratory Medicine, National Coordinating Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
2University of Lyon, INRAE, IVPC, Lyon, France
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Paolo Spagnolo
5Respiratory Disease Unit, Dept of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Claudia Valenzuela
6Pulmonology Dept, Hospital Universitario de la Princesa, Universidad Autonoma de Madrid, Madrid, Spain
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Martin Kolb
7Dept of Respiratory Medicine, Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
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Extract

Involvement of the respiratory system, the commonest extra-articular manifestation of rheumatoid arthritis (RA), occurs to some extent in a large proportion of patients with RA. Any of the pulmonary compartments can be affected, either secondary to RA itself, or in relation to drug toxicity or opportunistic infection [1]. RA-associated interstitial lung disease (RA-ILD) is an increasingly recognised complication of RA, in many ways similar to idiopathic pulmonary fibrosis [2]. Clinically relevant RA-ILD may be present in up to 10% of patients with RA, and is associated with significant morbidity and mortality [1, 3], with no optimal treatment determined.

Abstract

Methotrexate can induce subacute hypersensitivity pneumonitis, a potentially lethal condition that should lead to drug discontinuation; however, its use does not seem to be associated with increased risk of chronic fibrosing ILD in rheumatoid arthritis https://bit.ly/3sCyjji

Footnotes

  • Published in volume 57, issue 2 of the European Respiratory Journal on 11 February 2021; republished 15 February 2021 with amendments an author's forename.

  • Conflict of interest: V. Cottin has received fees for consultancy from Actelion, Boehringer Ingelheim, Bayer, Biogen Idec, GSK, MSD, Novartis, Roche, Sanofi and Galapagos; has received lecture fees from Actelion, Boehringer Ingelheim, Novartis, Roche and Sanofi; has received reimbursement for travel to medical meetings from Actelion, Boehringer Ingelheim and Roche; has received fees for development of educational presentations from Boehringer Ingelheim; has acted as a member of an adjudication committee for Gilead; has received grants to his institution from Boehringer Ingelheim and Roche; and has acted as a member of data and safety monitoring boards for Promedior, Celgene and Galecto.

  • Conflict of interest: E. Bendstrup has nothing to disclose.

  • Conflict of interest: P. Bonniaud has nothing to disclose.

  • Conflict of interest: M. Nasser has nothing to disclose.

  • Conflict of interest: P. Spagnolo has nothing to disclose.

  • Conflict of interest: C. Valenzuela has nothing to disclose.

  • Conflict of interest: M. Kolb has received grants and personal fees from Roche, Boehringer Ingelheim, GSK, Gilead, Prometic (now Liminal Biosciences) and Pieris; grants from Avalyn; and personal fees from AstraZeneca, Novartis, Cipla, Bluefin Biomedicine, Algernon and Medscape

  • Support statement: This work was support by the Hospices Civils de Lyon and Université de Lyon. Funding information for this article has been deposited with the Crossref Funder Registry.

  • Received January 10, 2021.
  • Accepted January 13, 2021.
  • ©The authors 2021. For reproduction rights and permissions contact permissions{at}ersnet.org
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Vol 57 Issue 2 Table of Contents
European Respiratory Journal: 57 (2)
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The case of methotrexate and the lung: Dr Jekyll and Mr Hyde
Vincent Cottin, Elisabeth Bendstrup, Philippe Bonniaud, Mouhamad Nasser, Paolo Spagnolo, Claudia Valenzuela, Martin Kolb
European Respiratory Journal Feb 2021, 57 (2) 2100079; DOI: 10.1183/13993003.00079-2021

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The case of methotrexate and the lung: Dr Jekyll and Mr Hyde
Vincent Cottin, Elisabeth Bendstrup, Philippe Bonniaud, Mouhamad Nasser, Paolo Spagnolo, Claudia Valenzuela, Martin Kolb
European Respiratory Journal Feb 2021, 57 (2) 2100079; DOI: 10.1183/13993003.00079-2021
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