Session Title: Rheumatoid Arthritis - Clinical Aspects Poster Session III
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
We examined the clinical features of the cases after discontinuation or decrease of dosage of MTX in the MTX-LPD.
We retrospectively examined a patient background, a clinical presentation, a histopathology, and clinical course in 19 patients of Osaka City University Hospital rheumatology clinic from 2006 through 2014.
These cases were average age 64.5 y.o. (37-81), 3 male/16 female , 8.1 mg/week of MTX average dosage, 1,510 mg (312-6110 mg) of MTX average total doses, and mean DAS28(CRP) of 3.65 (2.3-5.46) at the MTX-LPD onset.
Lymph node biopsy performed in 16 patients showed reactive lymphadenopathy syndrome 6, Diffuse large B-cell lymphoma (DLBCL) 5, Hodgkin’s lymphoma 3, primary effusion lymphoma (PEL) 1, and non-specific Peripheral T-cell lymphoma 1. Epstein-Barr virus (EBV) DNA in blood specimen was examined in 4 cases resulting 2 positive, 2 negative.
16 cases improved by discontinuation of MTX spontaneously, but 3 cases required chemotherapy. It is reported that MTX-LPD often showed EBV-positive in histopathology, and the pathological type of EBV-positive LPD could show both the B-cell and the T-cells. One of 16 patients which performed lymph node biopsy was diagnosed T-cell lymphoma, and EBV was proved even in this case histologically. This case also improved spontaneously after discontinuation of MTX. The mechanism is not revealed, but the EBV infects both B-cells and T-cells.
There was no difference in the ratio of the histopathology compared with malignant lymphoma besides iatrogenic immunodeficiency-associated lymphproliferative disorders. Contribution of the EBV infection is suggested in MTX-LPD development. In this study, it is suggested that the mechanism is applicable in T-cell lymphoma, although all cases are not EBV-positive in histopathology. Further study is necessary on revealing the mechanism of pathogenesis of MTX-LPD, and EBV infection to T-cells.
To cite this abstract in AMA style:HAYASHI N, HAMAMOTO K, YODA K, YODA M, YAMADA S, GOTO H, INABA M. Characteristics of Histopathology and Clinical Course of 19 Cases That Developed a Lymphoproliferative Disease (LPD) during Methotrexate (MTX) Treatment. [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/characteristics-of-histopathology-and-clinical-course-of-19-cases-that-developed-a-lymphoproliferative-disease-lpd-during-methotrexate-mtx-treatment/. Accessed October 19, 2021.
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