Rheumatology has a comprehensive overview of methotrexate (MTX) and the risk of lung injury, MTX-related pneumonitis and interstitial lung disease (RA-ILD) with rheumatoid arthritis (RA). Past reports suggest the frequence of MTX-pneumonitis to be between 0.3 and 11.6%; recent studies suggest it may be much lower.
Clinical criteria for the diagnosis of MTX pneumonitis (acute, reversible) and RA-ILD (chronic, progressive) are quite different and are reviewed in this article.
Despite the large numbers of clinical trials that include MTX, very few of these are suitable for use to analyse the risk of MTX pneumonitis.
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