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Methotrexate

Amethopterin


Presentation

  • In the present cases, discontinuing MTX and debridement of the necrotic bone were effective. This report describes 3 cases of MTX-related LPD in patients with longstanding rheumatoid arthritis (RA) who presented with ONJ.[ncbi.nlm.nih.gov]
  • MTX-induced neurotoxicity occasionally manifests with a stroke-like presentation that is difficult to distinguish from genuine stroke.[ncbi.nlm.nih.gov]
  • Here, we present evidence to support the role of common drug interactions and low vitamin B 12 levels in potentiating methotrexate neurotoxicity.[ncbi.nlm.nih.gov]
  • CASE PRESENTATION: A 77-year-old African American woman with a history of rheumatoid arthritis presented with progressively worsening shortness of breath and nonproductive cough.[ncbi.nlm.nih.gov]
  • A 31-year-old female with seropositive rheumatoid arthritis on methotrexate therapy presented with a 2-week history of sudden onset of painful infiltrated subcutaneous nodules on both forearms.[ncbi.nlm.nih.gov]
Anemia
  • […] therapy May cause renal damage leading to acute renal failure, especially in high doses Elimination is reduced in impaired renal function, ascites, or pleural effusions; reduce dose and monitor carefully for toxicity Bone marrow suppression, aplastic anemia[web.archive.org]
  • Uncommon (0.1% to 1%): Pancytopenia, agranulocytosis, hematopoietic disorders Rare (0.01% to 0.1%): Megaloblastic anemia Very rare (less than 0.01%): Severe bone marrow depression, aplastic anemia, lymphadenopathy, lymphoproliferative disorders (partly[drugs.com]
  • Uncommon (0.1% to 1%): Pancytopenia , agranulocytosis , hematopoietic disorders Rare (0.01% to 0.1%): Megaloblastic anemia Very rare (less than 0.01%): Severe bone marrow depression , aplastic anemia , lymphadenopathy , lymphoproliferative disorders[drugs.com]
Multiple Congenital Anomalies
  • The fetus was found prenatally to be suffering from multiple congenital anomalies. At birth the infant demonstrated many of the abnormalities commonly associated with fetal methotrexate syndrome, including craniosynostosis and talipes equinovarus.[ncbi.nlm.nih.gov]
Intermittent Fever
  • Abstract A 62-year-old woman with rheumatoid arthritis and secondary Sjögren's syndrome took methotrexate (MTX) 5 mg three times a week regularly but gradually developed an intermittent fever, oral ulcers and productive cough with mucopurulent sputum[ncbi.nlm.nih.gov]
Exanthema
  • ., arterial thrombosis, cerebral thrombosis, thrombophlebitis, deep vein thrombosis , retinal vein thrombosis, pulmonary embolism ), myocardial ischemia Frequency not reported : Cerebral edema [ Ref ] Dermatologic Common (1% to 10%): Exanthema, erythema[drugs.com]
  • ., arterial thrombosis, cerebral thrombosis, thrombophlebitis, deep vein thrombosis, retinal vein thrombosis, pulmonary embolism ), myocardial ischemia Frequency not reported : Cerebral edema [ Ref ] Dermatologic Common (1% to 10%): Exanthema, erythema[drugs.com]
Subcutaneous Nodule
  • A 31-year-old female with seropositive rheumatoid arthritis on methotrexate therapy presented with a 2-week history of sudden onset of painful infiltrated subcutaneous nodules on both forearms.[ncbi.nlm.nih.gov]
Seizure
  • Treatment (or methods): Both patients developed acute neurotoxicity with confusion, pain and seizures. Intravenous dexamethasone and folinic acid (leucovorin) was given. Exchange of cerebrospinal fluid was performed.[ncbi.nlm.nih.gov]
  • Signs and symptoms may range from headaches, dizziness, and mood disorders to seizures and stroke-like symptoms.[ncbi.nlm.nih.gov]
  • Tell your doctor if you have diarrhea , mouth sores, cough, shortness of breath, upper stomach pain, dark urine, numbness or tingling, muscle weakness, confusion, seizure, or skin rash that spreads and causes blistering and peeling.[drugs.com]
  • More Common Black, tarry stools blood in the urine or stools bloody vomit diarrhea joint pain reddening of the skin sores in the mouth or lips stomach pain swelling of the feet or lower legs Less Common Back pain blurred vision confusion convulsions ( seizures[drugs.com]
Flaccid Paralysis
  • An 18-year-old woman with a history of ALL presented to the emergency department with acute onset of right-sided facial paralysis, right upper extremity flaccid paralysis, and right lower extremity weakness after receiving MTX therapy 3 days earlier.[ncbi.nlm.nih.gov]

Workup

Pericardial Effusion
  • effusion, pericardial tamponade, hypotension , thromboembolic events (e.g., arterial thrombosis, cerebral thrombosis, thrombophlebitis, deep vein thrombosis , retinal vein thrombosis, pulmonary embolism ), myocardial ischemia Frequency not reported :[drugs.com]
  • effusion, pericardial tamponade, hypotension, thromboembolic events (e.g., arterial thrombosis, cerebral thrombosis, thrombophlebitis, deep vein thrombosis, retinal vein thrombosis, pulmonary embolism ), myocardial ischemia Frequency not reported : Cerebral[drugs.com]
Macrocytosis
  • Common: GI symptoms (mucositis, nausea, dyspepsia, diarrhea), Skin (macular rash), Neurotoxicity, Macrocytosis.[errolozdalga.com]

Treatment

  • PURPOSE: Intravenous immunoglobulin (IVIG) is the standard treatment for Kawasaki disease (KD). However, there is still no standard treatment for IVIG-resistant KD.[ncbi.nlm.nih.gov]
  • Median duration of combined treatment was 13 months. Combined treatment was discontinued in three patients due to side effects. Previous failure of methotrexate monotherapy did not alter the duration of the combined treatment.[ncbi.nlm.nih.gov]
  • Treatment by oral administration of MTX (7.5   2.5 mg) alone was performed.[ncbi.nlm.nih.gov]
  • The median ( range) pre-treatment serum hCG was 2039 (1031-8575) IU/L and nine had pre-treatment hCGs levels 3000 IU/L. The treatment successfully resolved 86% (24/28) cases with a median ( range) time to resolution of 32 (18-67) days.[ncbi.nlm.nih.gov]
  • EMDR treatment can potentially increase quality of life of affected patients and enable continued MTX treatment.[ncbi.nlm.nih.gov]

Prognosis

  • Treatment and prognosis Overall prognosis would depend on the exact form of the disease. In general, the prognosis is considered good, with most patients improving despite the continuation of therapy.[radiopaedia.org]
  • : To assess cost effectiveness of abatacept versus adalimumab, each administered with methotrexate, in treating patients with rheumatoid arthritis (RA) stratified according to baseline anticitrullinated protein antibody (ACPA) levels (marker of poor prognosis[ncbi.nlm.nih.gov]
  • Comorbidities and relative dose intensity for methotrexate are important for the prognosis of elderly patients with PCNSL. These results must be confirmed in prospective trials.[ncbi.nlm.nih.gov]
  • Prognosis Prognosis depends on the extent and severity of malformations.[orpha.net]
  • […] with poor-prognosis metastatic trophoblastic neoplasms, methotrexate in combination with etoposide, dactinomycin, vincristine, and cyclophosphamide (EMA-CO) is a standard treatment option. 268 A dose-intensive regimen, EMA-CE, in which etoposide and[drugs.com]

Etiology

  • Monto Elsevier , 22 oct. 2013 - 730 pagini The Leukemias: Etiology, Pathophysiology, and Treatment documents the proceedings of an International Symposium on The Leukemias: Etiology and Pathophysiology, held at Henry Ford Hospital, Detroit, Michigan,[books.google.ro]
  • Methotrexate lung disease is the specific etiological type of drug-induced lung disease.[radiopaedia.org]
  • Etiology The syndrome is caused by exposure during the first trimester of pregnancy to aminopterin or MTX, two folate antagonists.[orpha.net]

Epidemiology

  • Abstract There is good epidemiological evidence that patients with autoimmune rheumatic disease states, particularly rheumatoid arthritis, have an increased risk of cardiovascular morbidity and mortality when compared to the general population.[ncbi.nlm.nih.gov]
  • Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York. 24 Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman[ncbi.nlm.nih.gov]
  • Summary Epidemiology At least 51 cases have been reported in the last decades; prevalence and incidence values are not available.[orpha.net]
  • This article will provide a comprehensive review of Dermatitis herpetiformis, including its epidemiology, clinical and pathological findings, diagnostic evaluation, and management. Read more[skintherapyletter.com]
  • Clinical and epidemiological research Optimal dosage and route of administration of methotrexate in rheumatoid arthritis: a systematic review of the literature K Visser , D van der Heijde Department of Rheumatology, Leiden University Medical Center, Leiden[ard.bmj.com]
Sex distribution
Age distribution

Pathophysiology

  • Monto Elsevier , 22 oct. 2013 - 730 pagini The Leukemias: Etiology, Pathophysiology, and Treatment documents the proceedings of an International Symposium on The Leukemias: Etiology and Pathophysiology, held at Henry Ford Hospital, Detroit, Michigan,[books.google.ro]
  • […] disorders or settings where the test may be helpful Following therapy, serum concentration is used to judge whether the drug is being cleared appropriately and verify that a nontoxic concentration has been attained Clinical Information Discusses physiology, pathophysiology[mayomedicallaboratories.com]
  • Pathophysiology Mechanism Antimetabolite Chemotherapy (Cell Cycle Specific) S-Phase toxin (DNA synthesis phase) Folic Acid structural analog Competitively inhibits at DHF Reductase Inhibits de novo Pyrimidine synthesis Effects Suppresses DNA synthesis[fpnotebook.com]

Prevention

  • […] skin disorders or for the routine care of skin. antineoplastic agent A substance that inhibits or prevents the proliferation of neoplasms. antirheumatic drug A drug used to treat rheumatoid arthritis.[ebi.ac.uk]
  • Efforts to prevent such overdoses are of vital importance.[ncbi.nlm.nih.gov]
  • In all patients receiving HD-MTX, plasma MTX levels are monitored mainly to anticipate rescue therapy to prevent adverse events.[ncbi.nlm.nih.gov]
  • Background: Folate supplementation in women of reproductive age has a well-established role in the prevention of neural tube defects. Methotrexate is a commonly used drug which functions by inhibiting normal folate metabolism in active cells.[ncbi.nlm.nih.gov]
  • Several mechanisms have been proposed including inhibition of T cell proliferation via its effects on purine and pyrimidine metabolism, inhibition of transmethylation reactions required for the prevention of T cell cytotoxicity, interference with glutathione[doi.org]

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