Clinical characteristics and incidence of methotrexate-related lymphoproliferative disorders of patients with rheumatoid arthritis. Issue 5 (September 2014)

• Record Type: Journal Article
• Authors: Yoshida, Yuji; Takahashi, Yuko; Yamashita, Hiroyuki; Kano, Toshikazu; Kaneko, Hiroshi; Mimori, Akio
• Is Part Of: Modern rheumatology. Volume 24:Issue 5(2014)
• Page Start: 763
• Page End: 765
• Publication Date: 2014-09
• Subjects: Rheumatology -- Periodicals; 616.723005
• DOI: 10.3109/14397595.2013.878016
• Languages: English
• ISSNs: 1439-7595

Abstract

<abstract> <title>Abstract</title> <p> <italic>Objective.</italic> To investigate the incidence and clinical features of methotrexate (MTX)-related lymphoproliferative disorders (MTX-LPDs) in patients with rheumatoid arthritis (RA).</p> <p> <italic>Patients.</italic> In total, 589 RA outpatients were examined at the National Center for Global Health and Medicine in the period from January 1990 to October 2010.</p> <p> <italic>Results.</italic> MTX was used in 403 cases, and the duration of follow-up was 2379 person-years. Four patients developed MTX-LPDs; the incidence of MTX-LPDs was calculated as 0.00168/person-year and the standardized incidence as 8.21 (95% CI: 0.16–24.30). The mean total dosage of MTX was 1142 ± 871 mg, and the dosage at LPD onset was 7.4 ± 1.9 mg/week. The patients who developed MTX-LPDs had significantly shorter disease duration of RA compared with the patients who had not received MTX, but who had not progressed to LPDs (3.1 years vs. 12.5 years; <italic>P</italic> = 0.01). The following LPD subtypes were observed: diffuse large B-cell lymphoma (<italic>N</italic> = 2); Hodgkin's lymphoma (<italic>N</italic> = 1); and T-cell lymphoma (<italic>N</italic> = 1). After withdrawal of MTX, two of these patients showed spontaneous regression of the tumor, one did not have a recurrence, while the other patient relapsed and required chemotherapy.</p> <p> <italic>Conclusion.</italic> Our study revealed that MTX-LPDs are not rare complications of RA outpatients. The MTX-LPDs were associated with a relatively shorter RA duration, and half of them showed tumor regression after MTX withdrawal, which suggested an association with MTX. It is important to consider the possibility of MTX-LPD in RA patients who have received MTX.</p> </abstract>