Factors Associated with Pneumocystis jirovecii Pneumonia in Patients with Rheumatoid Arthritis Receiving Methotrexate: A Single-center Retrospective Study

Objective To investigate the risk factors for the development of Pneumocystis jirovecii pneumonia (PCP) in patients with rheumatoid arthritis (RA) undergoing methotrexate (MTX) therapy. Methods This single-center retrospective cohort study included consecutive patients with RA who received MTX for a...

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Bibliographic Details
Published in:Internal Medicine 2022/04/01, Vol.61(7), pp.997-1006
Main Authors: Ohmura, Shin-ichiro, Homma, Yoichiro, Masui, Takayuki, Miyamoto, Toshiaki
Format: Article
Language:English
Subjects:
Albumin
Antirheumatic Agents - adverse effects
Arthritis, Rheumatoid - complications
Arthritis, Rheumatoid - drug therapy
disease-modifying anti-rheumatic drugs
Humans
Internal medicine
Janus kinase
Lung diseases
Methotrexate
Methotrexate - adverse effects
Original
Pneumocystis carinii
Pneumocystis jirovecii
pneumocystis pneumonia
Pneumonia
Pneumonia, Pneumocystis - chemically induced
Pneumonia, Pneumocystis - complications
Pneumonia, Pneumocystis - epidemiology
Population studies
Prednisolone
Prophylaxis
Retrospective Studies
Rheumatoid arthritis
Risk factors
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Summary:Objective To investigate the risk factors for the development of Pneumocystis jirovecii pneumonia (PCP) in patients with rheumatoid arthritis (RA) undergoing methotrexate (MTX) therapy. Methods This single-center retrospective cohort study included consecutive patients with RA who received MTX for at least one year. The study population was divided into PCP and non-PCP groups, depending on the development of PCP, and their characteristics were compared. We excluded patients who received biologic disease-modifying anti-rheumatic drugs (DMARDs), Janus kinase inhibitors, and anti-PCP drugs for prophylaxis. Results Thirteen patients developed PCP, and 333 did not develop PCP. At the initiation of MTX therapy, the PCP group had lower serum albumin levels, a higher frequency of pulmonary disease and administration of DMARDs, and received a higher dosage of prednisolone (PSL) than the non-PCP group. A multivariate Cox regression analysis revealed that the concomitant use of PSL [hazard ratio (HR) 5.50, p=0.003], other DMARDs (HR 5.98, p=0.002), and serum albumin
ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.8205-21