Internal Med Medical News about methotrexate-induced pneumonitis;immunological response

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Variation of immunological response in methotrexate-induced pneumonitis
Rheumatology, 10/23/08

Chikura B et al. - Variation of immunological responses in MTX-induced pneumonitis (MTX-P) with the degree of exposure to MTX divides MTX-P into 2 groups: type 1 MTX-P occurs early, predominated by neutrophils, lung fibrosis and has a high mortality; and type 2 MTX-P that occurs late, predominated by lymphocytes, has less lung fibrosis and low mortality.

Methods

Study to assess the variation of inflammatory cell counts and lung biopsy findings with the degree of exposure to MTX therapy
56 cases of MTX-P on low-dose MTX (5–30 mg) were identified
The median cumulative dose was 300 mg
6 mos was used to divide pts into early- and late-onset MTX-P groups

Results

Neutrophil counts in the peripheral blood and bronchoalveolar lavage (BAL) were raised in the low MTX vs high MTX-exposure group
Similar findings in early-onset vs late-onset group
Lymphocytes in BAL were higher in the high MTX-exposure group vs low-dose cumulative group
11% recorded deaths, all in the low MTX-exposure group
Early-onset/low MTX-exposure groups had a high prevalence of lung fibrosis

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