Methotrexate-Associated Lymphoproliferative Disorder in Two Patients with Rheumatoid Arthritis Whose Treatment Included Kampo Medicines

Tatsuya Nogami, Makoto Fujimoto, Hidetoshi Watari, Naotoshi Shibahara and Yutaka Shimada

Department of Japanese Oriental Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan Department of Kampo Diagnostics, Institute of Natural Medicine, University of Toyama, Japan

^*Correspondance to: Tatsuya Nogami 

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Abstract:

Methotrexate (MTX) is used to treat Rheumatoid Arthritis (RA). Methotrexate-associated Lymphoproliferative Disorder (MTX-LPD) has been reported. Here we report two cases of MTXLPD in patients with RA treated with MTX and Kampo medicines. Case 1 was a 70-year-old woman who developed MTX-LPD on MTX 8 mg, tacrolimus, and daibofuto. Case 2 was a 50-year-old woman who had had RA for 9 years and been treated with MTX 8 mg per week for 6 years; she developed MTX-LPD while also taking abatacept, bakumondoto, and unkeito. In case 1, MTX-LPD only resolved after discontinuation of MTX; her RA was subsequently controlled by Minocycline and daibofuto. In case 2, MTX-LPD resolved after treatment with rituximab; her RA was then controlled with prednisolone 3 mg, iguratimod 50 mg, and Negative Nepi or Rio. Some Kampo medicines may have immunoregulatory activity and affect the serum MTX level. These medicines should be used cautiously in patients with RA if they are being treated with MTX.

Keywords:

Rheumatoid arthritis; Kampo medicines; Methotrexate; Glycyrrhizae radix; Methotrexate-associated lymphoproliferative disorder

Cite the Article:

Nogami T, Fujimoto M, Watari H, Shibahara N, Shimada Y. Methotrexate- Associated Lymphoproliferative Disorder in Two Patients with Rheumatoid Arthritis Whose Treatment Included Kampo Medicines. Ann Clin Case Rep. 2020; 5: 1783.