Methotrexate and Pulmonary Fibrosis

[Tuppy66]

Hi All, I have had an awful cough and a rough voice since having a chest infection last Easter 2022 I was seen by ENT on the cancer pathway and was given the all clear but then referred to Respiratory they gave me a PET scan which was supposed to be repeated within 6 weeks of the 11th October last year, that still hasn’t happened 2 weeks before Xmas I was seen on an emergency GP appointment and given antibiotics for my cough and chest but they didn’t help I managed to get another appointment 3 weeks ago with my GP who is still trying to get through to the hospital he once again gave me more antibiotics but said that he thinks I may have developed pulmonary fibrosis I asked how come and he said as a result of my taking Methotrexate or my Autoimmune Disorder. Does anyone have any advice please or any information as to what might happen next I am quite worried now and also fed up of feeling like absolute rubbish. Thank you in advance.

[sylvi]

I had to stop MTX due to a ground glass appearance on my lungs. I don't know whether that is any help to you, but i personally would think if you had fibrosis they would get you off MTX.xxx

[wishbone]

I was diagnosed with PF 7 years ago. First detected by abnormalties in x-ray, then, from what I can make out, diagnosed by CT scan and lung function test. My chest consultant reckons it was caused by my RA and not methotrexate which I was taking at the time. He did tell me to stop taking methotreate not because it can affect the PF, but because it can cause a different lung condition which could mask the monitoring of the PF. Don't quote me here, but my consultant seemed to place more importance on shortness of breath rather than a cough, which I did have for several weeks in the early stages during a seriously bad RA flare, but only ocassionaly since.

[Runrig01]

I am asthmatic and in Sept 21, developed shortness of breath, which was initially blamed on my asthma. Changing meds didn’t help. My gp referred me to respiratory and dud a HRCT. The scan came back stating pulmonary fibrosis, so I was then seen urgently by respiratory. I didn’t have a cough, it was just the shortness of breath. I had lung function tests, and told to restart my MTX. She said that recent evidence shows that MTX doesn’t cause PF but actually delays the onset. She said that opinion was based on old poor research, and new stronger research was showing it nit to be the case. 7 months later she contacted me to say, that they’d sent my scans to the Brompton who said my lung damage was due to aspirating acid, that it could still turn into PF but just needed monitoring for now. I have yearly lung function tests and regular appointments with my specialist. She changed my inhalers, and started new medication for my lungs and a much stronger PPI, which is helping. In hindsight reflux had coincided with the shortness of breath. Do I have an area of lung that is damaged due to acid, they also found I havd areas of Atelectasis, which is collapsed lung. I have ankylosing spondylitis which has fused my ribs, so I have no chest expansion. That’s what has contributed to the collapsed lung, and weakened my diaphragm, which has caused a hiatus hernia and allowed acid to get to my lungs. I would have thought that a PET scan would almost certainly have picked up signs of pulmonary fibrosis, so I wouldn’t worry too much

I should add that I’ve continued on my 25mg MTX throughout, due to the evidence now stating otherwise

Here’s an article discussing the role of MTX in PF.

emjreviews.com/rheumatology...

[Pitbull2017]

I'm just wondering when you've had chest or lung infections coughs colds etc in the past if you've stopped taking MTX for a week or two, I've taken MTX for over 20 years and with the okay from my consultant when I've had a bad cough or chest infection I've taken a holiday from MTX for one or two weeks to allow my immune system to fight off the infection, its worked for me obviously best to speak to your consultant first, I've now been in remission from RA for 4 years and I believe taking MTX is a large percentage of the reason for that

[Evie3]

i had chest infections on and off for two years. Eventually asked for a sputum test. It turns out i wasnt taking the correct antibiotic all that time and infection was just sitting in my tubes. Since having the correct antibiotic (Nov) I have been clear🤷‍♀️.

[medway-lady]

I have Cyclindrical Bronchiectasis and then was found by accident after 9 lots of antibiotics for a chest infection which then turned out to have been caused by human soup( a hot tub on a cruise ship) and the right antibiotic was prescribed as well as a full lung function test. I also have thepANCA gene so it could be genetic as I was advised I'd had it since birth and the cause was the Cystic Fibrosis gene but it didn't cause any issues until the bug from hell which turned out to be MRSA in the lung. But it was successfully treated and I did a pulmonary rehabilitation course which really helped. I never now use a private or health club hot tub, or holiday swimming pool only Council ones which are controlled (I hope) and have a pack of unopened antibiotics in the cupboard for past 3 as no infections but I do keep an eye on the use by date! In my case i only took MTX years before and only for a couple/three ? months so it definitely wasn't that. I don't know if that helps but do hope you get some help soon. Try looking up Huff coughing as that really helped me and see if you can see the Pulmonary Team too.

[BeachsideVia in reply to medway-lady]

no pool for me! On week 5 of Mtx, no major flares! I am concerned about my immune system and after exercising in our condo pool a few times, I have decided to stay out of the pool.

[KittyJ in reply to BeachsideVia]

mtx only brings your immune system back to what it should be if you didn’t have RA, so no need to worry about having a low immune system.