Methotrexate-induced organ toxicity in patients with rheumatoid arthritis: A review article.

Background: Globally, 0.5-1% general population are suffering from rheumatoid arthritis (RA). RA is a chronic systemic self-immune medicated inflammatory disorders, affects synovial fluids and the lining of synovial joints. To treat RA required multiple drug therapy such as glucocorticoids, nonsteroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs (DMARDs), and biologics. DMARDs such as methotrexate (MTX), hydroxychloroquine, and leflunomide are routinely used in RA either as a monotherapy or combination therapy. MTX is a well-established DMARD used as first-line therapy in RA due to cost-effectiveness and efficacious. Even though MTX acts as gold standard drug therapy in the management of RA, it possesses various toxicity that may be related to the organ. Organ related toxicity includes gastrointestinal (GI) toxicity, hematological toxicity, hepatic toxicity, renal toxicity, cutaneous toxicity, and infections. This leads to the withdrawal of MTX therapy in 5-57% of patients within 1-2 years. Hence, we aimed to conduct a review of case studies to identify the types and nature of MTX -induced organ toxicity and management of that toxicity. Search strategies: We conducted a medical database search to identify case studies and found a total of 27 case studies, having 40 RA patients presentation, who experienced MTX -induced organ toxicity. The mean age of RA patients experienced with MTX -induced organ toxicity was 66.2 years and the age of affected patients was ranging from 30 to 82 years. Maximum number (n = 30) of MTX toxicity was seen in 61-80 years group of RA patients. The MTX -induced organ toxicity was GI toxicity, hematological toxicity, pulmonary toxicity, hepatic toxicity, renal toxicity, cutaneous toxicity, and various types of infections. Conclusion: MTX -induced organ toxicity can occur at any stage of MTX therapy even after taking care of precautions. This toxicity may be acute or chronic. The severity lies mild to severe in nature and rarely even cause death. This toxicity enhances economic burden and suffering to the patients. [ABSTRACT FROM AUTHOR]