MTX, RA and the infection risk...... | Arthritis Information

Methotrexate, rheumatoid arthritis and infection risk—what is the evidence?
Rheumatology, 05/21/09

McLean-Tooke A et al. – Patients with RA have a significantly increased risk of infection, and this risk appears to be particularly increased in patients with increased disease severity, comorbidities and the use of corticosteroids. Infection rates are clearly increased with certain DMARDs (e.g. cyclophosphamide or AZA) but MTX appears to be associated with minimal, if any, increased infection risk.

Methods

Review to summarize the literature on infection risk associated with low-dose MTX use in pts with RA
Searches of MEDLINE, EMBASE, author's personal files and references from relevant articles
Search terms: ‘rheumatoid arthritis’, ‘infection’, ‘methotrexate’, ‘disease modifying agents’ and ‘varicella zoster’
English language papers only were reviewed

Results

RA pts have increased incidence of infection compared with the general population
Increased disease severity, corticosteroid use and comorbidities are associated with an increased infection risk
Low-dose MTX does not appear to increase infection risk in RA pts
Given that the management of RA is now aggressive treatment with DMARDs early in the disease course, before irreversible damage occurs