title: Pneumocystis jiroveci pneumonia in patients with rheumatoid arthritis treated with infliximab: a retrospective review and case-control study of 21 patients.
abstract: OBJECTIVE
  To establish proper management of Pneumocystis jiroveci pneumonia (PCP) in rheumatoid arthritis (RA) patients treated with infliximab. PCP has been observed in 0.4% of patients with RA treated with infliximab in Japan.
  
  
  METHODS
  Data from patients with RA (n = 21) who were diagnosed with PCP during infliximab treatment and from 102 patients with RA who did not develop PCP during infliximab therapy were collected from 14 rheumatology referral centers in Japan. A retrospective review of these patients and a case-control study to compare patients with and without PCP were performed.
  
  
  RESULTS
  The median length of time from the first infliximab infusion to the development of PCP was 8.5 weeks. At the onset of PCP, the median dosages of prednisolone and methotrexate were 7.5 mg/day and 8 mg/week, respectively. Pneumocystis jiroveci was microscopically identified in only 2 patients, although the polymerase chain reaction test for the organism was positive in 20 patients. The patients with PCP had significantly lower serum albumin levels (P < 0.001) and lower serum IgG levels (P < 0.001) than the patients without PCP. Computed tomography of the chest in all patients with PCP revealed ground-glass opacity either with sharp demarcation by interlobular septa or without interlobular septal boundaries. Sixteen of the 21 patients with PCP developed acute respiratory failure, but all survived.
  
  
  CONCLUSIONS
  PCP is a serious complication that may occur early in the course of infliximab therapy in patients with RA. For the proper clinical management of this infectious disease, physicians need to be aware of the possibility of PCP developing during infliximab therapy.
authors.affiliation: Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Komano
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Harigai
authors.forename: Ryuji
authors.initials: R
authors.lastname: Koike
authors.forename: Haruhito
authors.initials: H
authors.lastname: Sugiyama
authors.forename: Jun
authors.initials: J
authors.lastname: Ogawa
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Saito
authors.forename: Naoya
authors.initials: N
authors.lastname: Sekiguchi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Inoo
authors.forename: Ikuko
authors.initials: I
authors.lastname: Onishi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ohashi
authors.forename: Fujio
authors.initials: F
authors.lastname: Amamoto
authors.forename: Masayuki
authors.initials: M
authors.lastname: Miyata
authors.forename: Hideo
authors.initials: H
authors.lastname: Ohtsubo
authors.forename: Kazuko
authors.initials: K
authors.lastname: Hiramatsu
authors.forename: Masahiro
authors.initials: M
authors.lastname: Iwamoto
authors.forename: Seiji
authors.initials: S
authors.lastname: Minota
authors.forename: Naoki
authors.initials: N
authors.lastname: Matsuoka
authors.forename: Goichi
authors.initials: G
authors.lastname: Kageyama
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Imaizumi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tokuda
authors.forename: Yasumi
authors.initials: Y
authors.lastname: Okochi
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kudo
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Takeuchi
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Miyasaka
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D045363:Pneumocystis carinii / Q000302:isolation & purification; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
chemical_list: D000890:Anti-Infective Agents; D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000069285:Infliximab