Accelerated nodulosis and vasculitis during methotrexate therapy for rheumatoid arthritis.
Three women with classic rheumatoid arthritis, who were receiving weekly doses of methotrexate (MTX), developed accelerated subcutaneous nodulosis, despite good response to the drug. In 2 of the patients, the onset of nodulosis occurred within 3 months and 5 months, respectively, after starting MTX; in the third patient, it was observed only after 4 years of MTX therapy. In all 3 patients, the onset was unusually abrupt, with extensive distribution and remarkable nodule size. Additional manifestations of cutaneous vasculitis in 2 of the patients and Raynaud's phenomenon in the third appeared concomitantly with the nodulosis. Physicians prescribing MTX therapy for patients with rheumatoid arthritis should be aware of these potential complications.
Department of Rheumatology, Ichilov Hospital, Tel Aviv University, Sackler Faculty of Medicine, Israel.
R
R
Segal
D
D
Caspi
M
M
Tishler
B
B
Fishel
M
M
Yaron
D000368:Aged; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D011928:Raynaud Disease / Q000139:chemically induced; D012218:Rheumatoid Nodule / Q000139:chemically induced* / Q000473:pathology; D012867:Skin / Q000098:blood supply; D013997:Time Factors; D014657:Vasculitis / Q000139:chemically induced* / Q000473:pathology
D008727:Methotrexate