title: Prognosis of pneumocystis pneumonia complicated in patients with rheumatoid arthritis (RA) and non-RA rheumatic diseases.
abstract: Clinical presentation of pneumocystis pneumonia (PCP) during immunosuppressive therapy for rheumatic diseases was compared between patients with rheumatoid arthritis (RA; n = 7) and those without RA (non-RA; n = 12) based on a chart review. Both RA and non-RA patients with PCP were treated with methotrexate (n = 7) combined with steroids (n = 6) and/or biologics (n = 4). RA-PCP patients were found to have a higher mortality rate than non-RA-PCP patients (3/7 vs. 0/12, respectively; p = 0.036) due to a later exacerbation of interstitial pneumonia and a higher presentation rate of diffuse pulmonary lesions (4/7 vs. 1/12, respectively; p = 0.036) despite lower mean levels of serum beta-D: -glucan (314 ± 214 vs. 1139 ± 1114 pg/ml, respectively;  p = 0.02) that suggested a lower burden of Pneumocystis jirovecii. In conclusion, PCP in RA patients with existing pulmonary lesions may trigger subsequent progression to lethal interstitial pneumonia.
authors.affiliation: Division of Rheumatic Diseases, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Yuko
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Minemura
authors.forename: Yo
authors.initials: Y
authors.lastname: Ueda
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yamashita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kaneko
authors.forename: Akio
authors.initials: A
authors.lastname: Mimori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007564:Japan / Q000453:epidemiology; D017563:Lung Diseases, Interstitial / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D008297:Male; D008727:Methotrexate / Q000009:adverse effects; D008875:Middle Aged; D045363:Pneumocystis carinii / Q000302:isolation & purification; D011020:Pneumonia, Pneumocystis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D008727:Methotrexate