Allwyn Vijay, G (2010) Methotrexate Induced Pulmonary Toxicity in Psoriasis Patients. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION : Methotrexate is an anti-metabolite widely used in malignancy, rheumatoid arthritis and refractory cases of psoriasis. The value of low dose methotrexate is well established. Most patients are able to tolerate low dose methotrexate with generally sustained efficacy. The main pulmonary side effect of methotrexate is interstitial pneumonitis. Its incidence has been found to be about 7 to 8%, in studies in which methotrexate at antineoplastic doses was used, in combination with other cytotoxic agents6. There are evidences of pulmonary function defects in patients on long term low dose methotrexate in rheumatoid arthritis patients. Acute methotrexate induced pneumonitis has also been reported after low-dose therapy (<20 mg/wk) for rheumatoid arthritis. Pulmonary function test of methotrexate pneumonitis patients show restrictive pattern with impairment in diffusion capacity of carbon monoxide. It is known that in patients receiving other cytotoxic drugs such as bleomycin, abnormalities in pulmonary function can be detected before the patients become symptomatic. Because methotrexate is frequently used in patients suffering from conditions such as RA, dermatomyositis or sarcoidosis, which can be associated with interstitial lung disease, determining the exact role of methotrexate in the development of pulmonary complications in these patients seems to be difficult. Therefore, we conducted a cross-sectional study to analyse the findings found on chest x-rays, high resolution computed tomography (HRCT) and pulmonary function tests (PFT) in a cohort of patients without previous recognized interstitial lung disease who were taking methotrexate as a treatment for psoriatic arthritis, a condition not associated with pleuropulmonary disease. AIM OF THE STUDY : To know the incidence of pulmonary toxicity and derangements in pulmonary function in psoriasis patients taking Methotrexate on long term basis through DLco, spirometry and radiological evaluation. MATERIALS AND METHODS : This is a cross sectional study done by Institute of Thoracic Medicine, Chetpet and Government general hospital, Chennai during the period from march 2009 to September 2009. The study patients were from Department of Dermatology, Government General Hospital, Chennai. INCLUSION CRITERIA: 1. Psoriasis patients have taken more than 3 months of methotrexate with respiratory complaints, 2. Age group above 14 years, 3. Patients who were willing for the study and gave informed consent for the study, 4. Both sexes. EXCLUSION CRITERIA: Not able to perform PFT, Patients treated for pulmonary tuberculosis in the past, Patients known to have restrictive lung diseases due to other known causes like collagen vascular diseases. METHOD : All eligible Psoriasis patients who are on methotrexate therapy for more than 3 months (cumulative dosage exceeding 150mg) were subjected to detailed history taking, clinical examination, complete haemogram, liver function test, renal function test, spirometry, diffusion capacity of carbon monoxide and radiological examination including x-ray chest and HRCT Chest ( read by 2 independent readers).The data were tabulated and analysed. CONCLUSIONS : There were 3 (10%) patients with radiological evidence of methotrexate induced pulmonary fibrosis. There were 10 (33%) patients with restrictive pulmonary function defect without radiological evidence of methotrexate induced pulmonary fibrosis. There were 7 (23%) patients with diffusion defect in this study without radiological evidence of methotrexate induced pulmonary fibrosis. Of these 7 patients, 5 patients had spirometric defect in the form of restriction. There were 14 (47%) patients with symptoms, no radiological abnormality and no spirometric abnormalities. Of the above 14 patients, 2 patients (6.6%) had diffusion defect. Prevalence of pulmonary function abnormalities in this study matches similar studies elsewhere. DLco could be an early predictor of pulmonary function impairment in psoriasis Patients on long term methotrexate.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Methotrexate ; induced ; pulmonary toxicity ; psoriasis patients. |
| Subjects: | MEDICAL > Tuberculosis and Respiratory Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 28 Feb 2018 16:29 |
| Last Modified: | 28 Feb 2018 16:36 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5905 |
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