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MODERN RHEUMATOLOGY Vol.14 No.5
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A case of rheumatoid arthritis exhibiting accelerating rheumatoid pleurisy during low-dose weekly methotrexate therapy |
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Takashi Kato1,3, Yoshifumi Ubara1, Naoki Sawa1, Tetsuo Tagami1, Hideyuki Katori1, Fumi Takemoto1, Akihide Tanimoto2 and Kenmei Takaichi1 |
(1) Kidney Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan
(2) Division of Pathology, Toranomon Hospital, Tokyo, Japan
(3) Present address: Department of Rheumatology, Kameda Medical Center, 929 Higashi-cho, Kamogawa 296-8602, Japan |
Received: 02 February 2004 Accepted: 02 July 2004 |
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Abstract |
| A 75-year-old Japanese man suffering from rheumatoid arthritis (RA) had received methotrexate (MTX) treatment for 9 years and developed bilateral pleural thickening with exudative pleural effusions despite remission of the polyarthritis. A diagnosis of rheumatoid pleurisy, made by exclusion, was supported by the elevated rheumatoid factor level of the pleural fluid. The pleurisy developed concomitantly with MTX-induced leukocytopenia, and discontinuation of the MTX treatment partially improved the CRP level. These findings indicate a causal relation between the rheumatoid pleurisy and MTX and suggest that MTX therapy may be ineffective in the treatment of rheumatoid pleurisy. Treatment with 10mg of prednisolone and 100mg of cyclosporine A daily resulted in rapid resolution of the pleurisy. Although MTX-induced rheumatoid pleurisy is a rare condition, MTX therapy should be considered carefully in RA patients with concomitant rheumatoid pleurisy. |
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| Key words |
| Histology - Methotrexate (MTX) - Rheumatoid arthritis (RA) - Rheumatoid pericarditis - Rheumatoid pleurisy |
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