Palavras-chave
Neumonitis Intersticial
Artritis Reumatoide
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos
Enfermedades Pulmonares Intersticiales
Como Citar
Resumo
O metotrexato (MTX) é um agente imunomodulador utilizado como modificador de doenças reumatológicas, pode ter efeitos tóxicos principalmente nos níveis hematológicos, cutâneos e de hipersensibilidade que incluem órgãos como o pulmão, na forma de pneumonites. Apresentamos o caso clínico de uma paciente de 51 anos com artrite reumatoide (AR), que apresentou pneumonite induzida por metotrexato com melhora subsequente do quadro clínico após a suspensão do medicamento e início da corticoterapia. Diferente do que se possa pensar, a pneumonite por metotrexato, por ser tão rara, deve ser considerada um diagnóstico de exclusão, dada a semelhança do quadro clínico com entidades mais comuns, como doenças pulmonares infecciosas e inflamatórias e doenças autoimunes.
Atzeni F, Boiardi L, Sallì S, Benucci M, Sarzi-Puttini P. Lung involvement and drug-induced lung disease in patients with rheumatoid arthritis. Expert Rev Clin Immunol. 2013;9(7):649-57. https://pubmed.ncbi.nlm.nih.gov/23899235/
Dawson JK, Graham DR, Desmond J, Fewins HE, Lynch MP. Investigation of the chronic pulmonary effects of low-dose oral methotrexate in patients with rheumatoid arthritis: a prospective study incorporating HRCT scanning and pulmonary function tests. Rheumatology (Oxford). 2002;41(3):262-7. https://pubmed.ncbi.nlm.nih.gov/11934961/
Imokawa S, Colby TV, Leslie KO, Helmers RA. Methotrexate pneumonitis: review of the literature and histopathological findings in nine patients. Eur Respir J. 2000;15(2):373-81. https://pubmed.ncbi.nlm.nih.gov/10706507/
Kiely P, Busby AD, Nikiphorou E, Sullivan K, Walsh DA, Creamer P, et al. Is incident rheumatoid arthritis interstitial lung disease associated with methotrexate treatment? Results from a multivariate analysis in the ERAS and ERAN inception cohorts. BMJ Open. 2019;9(5):e028466. https://pubmed.ncbi.nlm.nih.gov/31061059/
Juge PA, Lee JS, Lau J, Kawano L, Rojas-Serrano J, Sebastiani M, et al. Methotrexate and rheumatoid arthritis associated interstitial lung disease. Eur Respir J. 2021;57(2):2000337. https://pubmed.ncbi.nlm.nih.gov/32646919/
Ibfelt EH, Jacobsen RK, Kopp TI, Cordtz R, Jakobsen AS, Seersholm N, et al. Op0232 Treatment with Methotrexate and Risk of Lung Disease in Patients with Rheumatoid Arthritis: A Nationwide Population-Based Cohort Study from Denmark. Annals of the Rheumatic Diseases. 2020;79(Suppl 1):147-8. https://pubmed.ncbi.nlm.nih.gov/32780828/
Barrera P, Laan RF, van Riel PL, Dekhuijzen PN, Boerbooms AM, van de Putte LB. Methotrexate-related pulmonary complications in rheumatoid arthritis. Ann Rheum Dis. 1994;53(7):434-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1005365/
Fragoulis GE, Nikiphorou E, Larsen J, Korsten P, Conway R. Methotrexate-associated pneumonitis, and rheumatoid arthritis-interstitial lung disease: current concepts for the diagnosis and treatment. Front Med. 2019;6:238. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6819370/
Searles G, McKendry RJ. Methotrexate pneumonitis in rheumatoid arthritis: potential risk factors. Four case reports and a review of the literature. J Rheumatol. 1987;14(6):1164-71. https://pubmed.ncbi.nlm.nih.gov/3325643/
Kremer JM, Alarcón GS, Weinblatt ME, Kaymakcian MV, Macaluso M, Cannon GW, et al. Clinical, laboratory, radiographic, and histopathologic features of methotrexate-associated lung injury in patients with rheumatoid arthritis: a multicenter study with literature review. Arthritis Rheum. 1997;40(10):1829-37. https://pubmed.ncbi.nlm.nih.gov/9336418/
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Copyright (c) 2022 Cristhian Emilio Herrera Céspedes, Catalina González Avilés, Olga Milena García Morales, Pierangely Prieto Campos