Severe Renal Impairment in a Patient with Recent Rheumatoid Arthritis Diagnosis following Methotrexate Initiation: A Case Report

Severe Renal Impairment in a Patient with Recent Rheumatoid Arthritis Diagnosis following Methotrexate Initiation: A Case Report

Rheumatoid arthritis (RA) is a chronic autoimmune disease frequently treated with immunosuppressive agents such as methotrexate (MTX). Although MTX is generally well-tolerated, it can lead to adverse effects, including renal impairment. We present a case of a patient with newly diagnosed RA who deve...

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Bibliographic Details
Published in:Journal of pharmacy & bioallied science Vol. 16; no. Suppl 2; pp. S1878 - S1882
Main Authors: Alharbi, Fahad Hamadan M, Almutairi, Faisal Abdullah S, Aljutayli, Ziyad Abdulrahman A, Albuhayji, Saleh Abdulaziz S, Alharbi, Hosam Dahaim D, Almutairi, Ahmed Abdullah S
Format: Journal Article
Language:English
Published: India Medknow Publications and Media Pvt. Ltd 01-04-2024
Medknow Publications & Media Pvt. Ltd
Wolters Kluwer - Medknow
Wolters Kluwer Medknow Publications
Subjects:
Antineutrophil cytoplasmic antibodies
Arthritis
Autoimmune diseases
Care and treatment
Case Report
Complications and side effects
Corticosteroids
Cyclophosphamide
Development and progression
Glomerulonephritis
Hemodialysis
Immunosuppressive agents
Immunotherapy
Medical research
Medical treatment
Medicine, Experimental
Methotrexate
Patient education
Renal function
renal impairment
Rheumatoid arthritis
Rheumatoid factor
Ulcers
Vasculitis
Methotrexate
rheumatoid arthritis
renal impairment
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Summary:Rheumatoid arthritis (RA) is a chronic autoimmune disease frequently treated with immunosuppressive agents such as methotrexate (MTX). Although MTX is generally well-tolerated, it can lead to adverse effects, including renal impairment. We present a case of a patient with newly diagnosed RA who developed severe renal impairment shortly after initiating MTX therapy. A 50-year-old male with recently diagnosed RA presented with vomiting, skin itching, mouth ulcers, and a pruritic rash, all occurring shortly after starting MTX treatment. These symptoms led to acute kidney injury (AKI), necessitating hemodialysis. The patient's symptoms and laboratory findings were indicative of ANCA-associated small-vessel vasculitis with a picture of rapidly progressive glomerulonephritis (RPGN). Treatment included discontinuation of MTX, hemodialysis, immunosuppressive therapy with corticosteroids and cyclophosphamide, and patient education. This case emphasizes the need for close monitoring of RA patients initiated on MTX therapy and prompt evaluation of renal function. Clinicians should be vigilant for signs of renal impairment and be prepared to initiate appropriate interventions, including discontinuation of MTX and consideration of immunosuppressive therapy, to optimize patient outcomes. Further research is warranted to understand better the mechanisms underlying renal complications in RA patients receiving MTX treatment.
Bibliography:ObjectType-Case Study-2
SourceType-Scholarly Journals-1
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ISSN:0976-4879
0975-7406
DOI:10.4103/jpbs.jpbs_1284_23