Background/Purpose:

Methotrexate-associated lymphoproliferative disorder(MTX-LPD) is rare but one of important complications in treatment of rheumatoid arthritis (RA). There are few reports about disease activity and optimal therapy of RA with MTX-LPD.

Methods:

We retrospectively analyzed background of patients, histology of LPD, treatment and disease activity of RA in 15 patients with MTX-LPD in our hospital between 2008 and 2014.

Results:

Our cases included 4 males and 11 females, and the median age of MTX-LPD onset was 70 years old (52-81). Average dose and period of MTX administration were 8.8 mg /week (4-16), 8.7 years (2.2-19.8), and 3681 mg in total (1372 -9485). Mean DAS28 (CRP) at MTX-LPD diagnosis was 2.00 (1.17-3.18). Extranodal lesions were observed in 8 cases. Three of 15 patients were diagnosed as Hodgikin lymphoma (HL), 2 as diffuse large B-cell lymphoma (DLBCL), 1 as Follicular lymphoma (FL), 1 as peripheral T-cell lymphoma (PTCL), 1 as Angioimmunoblastic T-cell lymphoma (AILT).

Lymphoproliferative lesions were improved spontaneously by discontinuation of MTX in 8 cases. Six of them showed relapse of RA in 3 to 65 months after MTX cessation, and Abatacept (ABT), administered in four cases, was effective without recurrence of LPD. Chemotherapy (CTx) was required in seven patients. Flare of arthritis, seen less common in CTx group, occurred in two cases in 18 and 36 months after CTx was finished. The propotion of patients associated with Sjögren’s syndrome (SS) was significantly larger in CTx group (57 % v.s. 0 %, p=0.026).

Conclusion:

It is suggested that RA flare is common after MTX-LPD and ABT can be safe and effective treatment in RA relapse. Absense of SS was associated with spontaneous remission of MTX-LPD.