Document Detail

Acute febrile toxic reaction in patients with refractory rheumatoid arthritis who are receiving combined therapy with methotrexate and azathioprine.
MedLine Citation:
PMID:  8651964     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To assess the frequency and clinical features of an acute febrile toxic reaction (AFTR) in patients with refractory rheumatoid arthritis (RA) receiving combined therapy with methotrexate (MTX) and azathioprine (AZA). METHODS: A cohort of 43 RA patients being treated with MTX/AZA combination therapy were studied. In all of them, RA had been refractory to single-therapy disease-modifying antirheumatic drugs. We analyzed the frequency and clinical features of AFTR, which consisted mainly of the development of fever, leukocytosis, and cutaneous leukocytoclastic vasculitis when AZA was added to the MTX regimen. RESULTS: Four of the 43 patients (9.3%) who had been receiving long-term, well-tolerated treatment with MTX (mean +/- SD 375.5 +/- 159.5 days, range 227-561 days) developed AFTR shortly (mean +/- SD 25.7 +/- 13.6 days, range 17-46 days) after the addition of AZA to the regimen. The AFTR resolved rapidly (3 +/- 1.4 days) after discontinuation of AZA and MTX. In 2 cases, rechallenge with AZA and MTX was linked to a new flare of AFTR. CONCLUSION: The knowledge of this side effect is particularly important because it mimics a severe infectious complication related to immunosuppressive therapy, and because rechallenge can produce severe toxicity. Most of the new combined therapies for RA do not seem to be more toxic than single-drug treatment. Nevertheless, clinicians should be aware of a possible increase in side effects due to drug interactions or some other unidentified mechanism.
R Blanco; V M Martínez-Taboada; M A González-Gay; J Armona; J L Fernández-Sueiro; M C González-Vela; V Rodríguez-Valverde
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Arthritis and rheumatism     Volume:  39     ISSN:  0004-3591     ISO Abbreviation:  Arthritis Rheum.     Publication Date:  1996 Jun 
Date Detail:
Created Date:  1996-07-22     Completed Date:  1996-07-22     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  0370605     Medline TA:  Arthritis Rheum     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1016-20     Citation Subset:  AIM; IM    
Hospital Universitario M. Valdecilla, Universidad de Cantabria, Santander, Spain.
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MeSH Terms
Acute Disease
Antirheumatic Agents / administration & dosage,  adverse effects*
Arthritis, Rheumatoid / drug therapy*
Azathioprine / administration & dosage,  adverse effects*
Cohort Studies
Drug Therapy, Combination
Fever / chemically induced*
Leukocytosis / chemically induced*
Methotrexate / administration & dosage*
Retrospective Studies
Time Factors
Vasculitis, Leukocytoclastic, Cutaneous / chemically induced*
Reg. No./Substance:
0/Antirheumatic Agents; 446-86-6/Azathioprine; 59-05-2/Methotrexate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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