Objective: to demonstrate association between the tardive dyskinesia and methotrexate therapy.

Background: Dystonia is found among patients taking methotrexate. However, methotrexate and tardive oro-bucco-lingual dyskinesia seems to be rare syndrome and no direct causality have been proven. Oral dyskinesia is characterized by abnormal involuntary movements of the jaw, lips and tongue.

Method: A 57-year-old-man with rheumatoid arthritis and suppurative hidradenitis was treated with adalimumab (SPT 40 mg/ml) for 12 months, but treatment was discontinued due to sepsis. Six months later, he has been on methotrexate therapy (SPT 15 mg once a week) and oral prednisone (12.5 mg daily) but developed oro-bucco-lingual dyskinesia two months after starting treatment. However, therapy was continued for two years with slight progression of dyskinesia symptoms. Brain MR was not performed because the patient has shrapnel in the extremitites. Brain CT was unremarkable. Pharmacogenetic of MDR1 (ABCB1) 1236>T allele which is involved in metabolism of methotrexate revealed C/T genotype and MDR1 (ABCB1) 3435C>T C/T genotype, indicating intermediate transport acitivity.

Results: After withdrawal of methotrexate the patient experienced a gradual improvement of the dyskinesia. Use of the Naranjo probability scale indicated a probable relationship between the tardive dyskinesia and methotrexate therapy.

Conclusion: Until further evidence, side effects of a current treatment with methotrexate in a patient presenting with dyskinesia need to be considered.

« Back to 2022 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/oro-bucco-lingual-dyskinesia-as-a-side-effect-of-methotrexate-therapy/