MAUI, HAWAII – Methotrexate is the most effective therapy for granulomatous mastitis, according to Anna Postolova, MD, a rheumatology fellow at Stanford (Calif.) University.
Granulomatous mastitis is a rare inflammatory disease of the breast of uncertain but possibly autoimmune etiology. The most common treatments – antibiotics, prednisone, and incision and drainage – are often ineffective and have a roughly 50% recurrence rate. That’s why Stanford rheumatologists began using methotrexate more than a decade ago with impressive results, she explained at the 2018 Rheumatology Winter Clinical Symposium.
Presenting symptoms of granulomatous mastitis include unilateral or bilateral pain, palpable mass, redness, swelling, skin induration, erythema, abscess and/or fistula formation, and discharge. The differential diagnosis involves periductal mastitis, breast cancer, infection, sarcoidosis, and granulomatosis with polyangiitis. Diagnosis of granulomatous mastitis requires histologic examination of a biopsy specimen.