TY - JOUR T1 - Methotrexate and rheumatoid arthritis associated interstitial lung disease JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.00337-2020 VL - 57 IS - 2 SP - 2000337 AU - Pierre-Antoine Juge AU - Joyce S. Lee AU - Jessica Lau AU - Leticia Kawano-Dourado AU - Jorge Rojas Serrano AU - Marco Sebastiani AU - Gouri Koduri AU - Eric Matteson AU - Karina Bonfiglioli AU - Marcio Sawamura AU - Ronaldo Kairalla AU - Lorenzo Cavagna AU - Emanuele Bozzalla Cassione AU - Andreina Manfredi AU - Mayra Mejia AU - Pedro Rodríguez-Henriquez AU - Montserrat I. González-Pérez AU - Ramcés Falfán-Valencia AU - Ivette Buendia-Roldán AU - Gloria Pérez-Rubio AU - Esther Ebstein AU - Steven Gazal AU - Raphaël Borie AU - Sébastien Ottaviani AU - Caroline Kannengiesser AU - Benoît Wallaert AU - Yurdagul Uzunhan AU - Hilario Nunes AU - Dominique Valeyre AU - Nathalie Saidenberg-Kermanac'h AU - Marie-Christophe Boissier AU - Lidwine Wemeau-Stervinou AU - René-Marc Flipo AU - Sylvain Marchand-Adam AU - Pascal Richette AU - Yannick Allanore AU - Claire Dromer AU - Marie-Elise Truchetet AU - Christophe Richez AU - Thierry Schaeverbeke AU - Huguette Lioté AU - Gabriel Thabut AU - Kevin D. Deane AU - Joshua J. Solomon AU - Tracy Doyle AU - Jay H. Ryu AU - Ivan Rosas AU - V. Michael Holers AU - Catherine Boileau AU - Marie-Pierre Debray AU - Raphaël Porcher AU - David A. Schwartz AU - Robert Vassallo AU - Bruno Crestani AU - Philippe Dieudé Y1 - 2021/02/01 UR - http://erj.ersjournals.com/content/57/2/2000337.abstract N2 - Question addressed by the study Methotrexate (MTX) is a key anchor drug for rheumatoid arthritis (RA) management. Fibrotic interstitial lung disease (ILD) is a common complication of RA. Whether MTX exposure increases the risk of ILD in patients with RA is disputed. We aimed to evaluate the association of prior MTX use with development of RA-ILD.Methods Through a case–control study design with discovery and international replication samples, we examined the association of MTX exposure with ILD in 410 patients with chronic fibrotic ILD associated with RA (RA-ILD) and 673 patients with RA without ILD. Estimates were pooled over the different samples using meta-analysis techniques.Results Analysis of the discovery sample revealed an inverse relationship between MTX exposure and RA-ILD (adjusted OR 0.46, 95% CI 0.24–0.90; p=0.022), which was confirmed in the replication samples (pooled adjusted OR 0.39, 95% CI 0.19–0.79; p=0.009). The combined estimate using both the derivation and validation samples revealed an adjusted OR of 0.43 (95% CI 0.26–0.69; p=0.0006). MTX ever-users were less frequent among patients with RA-ILD compared to those without ILD, irrespective of chest high-resolution computed tomography pattern. In patients with RA-ILD, ILD detection was significantly delayed in MTX ever-users compared to never-users (11.4±10.4 years and 4.0±7.4 years, respectively; p<0.001).Answer to the question Our results suggest that MTX use is not associated with an increased risk of RA-ILD in patients with RA, and that ILD was detected later in MTX-treated patients.This multi-ethnic case–control study showed that methotrexate use is not associated with an increased risk of interstitial lung disease in patients with rheumatoid arthritis https://bit.ly/3fC8skd ER -