Lung Disease in Methotrexate-Treated Patients with Rheumatoid Arthritis

Pulmonary manifestations (e.g., interstitial lung disease, pleural effusions, nodules) are common in patients with rheumatoid arthritis (RA); the differential diagnosis includes infection, RA itself, and adverse effects of RA drugs. Drugs that have been implicated in causing pulmonary complications include the nonbiologic agents sulfasalazine, methotrexate, and leflunomide, as well as several biologic agents. Methotrexate has been implicated most often, but incidence of methotrexate-related lung disease among patients with RA is unknown. To assess risk for pulmonary disease among methotrexate-treated RA patients, investigators conducted a meta-analysis of 22 randomized, controlled trials (duration range, 24–104 weeks) of methotrexate versus…