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Methotrexate-induced lung injury in patients with rheumatoid arthritis occurs with peripheral blood lymphocyte count decrease
  1. S Inokuma1,
  2. H Kono1,
  3. Y Kohno2,
  4. K Hiramatsu1,
  5. K Ito1,
  6. K Shiratori1,
  7. J Yamazaki1,
  8. H Nakayama1,
  9. H Shoda1,
  10. Y Tanaka1
  1. 1Department of Allergy and Immunological Diseases, Tokyo Metropolitan Komagome Hospital, Japan
  2. 2Department of Internal Medicine, The Second Hospital, Tokyo Women’s Medical School, Japan
  1. Correspondence to:
    Dr S Inokuma
    Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan; inokuma{at}

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Pulsed methotrexate (MTX) treatment, of which the standard dose for Japanese patients with rheumatoid arthritis (RA) approved by the National Health Insurance System is 2–8 mg/week, is still the standard regimen. However, life threatening adverse reactions to this treatment, including lung injury, remain to be elucidated in detail.

We treated 11 patients with RA who developed lung injury during MTX treatment. Their clinical and laboratory features were examined retrospectively, focusing mainly on the changes in peripheral blood lymphocyte count.

The 11 patients (three men, eight women) had a mean (SD) age of 69.8 (7.8) years. All the patients had taken non-steroidal anti-inflammatory drugs, and nine had received steroids with a mean (SD) prednisolone dose of 6.6 (2.9) mg/day.

All of them responded well to MTX, when evaluated by American College of Rheumatology 20 core set.1 The dose of MTX had been increased …

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