title: Clinical characteristics and risk factors for Pneumocystis jirovecii pneumonia in patients with rheumatoid arthritis receiving adalimumab: a retrospective review and case-control study of 17 patients.
abstract: OBJECTIVE
  To investigate the clinical characteristics and risk factors of Pneumocystis jirovecii pneumonia (PCP) in rheumatoid arthritis (RA) patients treated with adalimumab.
  
  
  METHODS
  We conducted a multicenter, retrospective, case-control study to compare RA patients treated with adalimumab with and without PCP. Data from 17 RA patients who were diagnosed with PCP and from 89 RA patients who did not develop PCP during adalimumab treatment were collected.
  
  
  RESULTS
  For the PCP patients, the median age was 68 years old, with a median RA disease duration of eight years. The median length of time from the first adalimumab injection to the development of PCP was 12 weeks. At the onset of PCP, the median dosages of prednisolone and methotrexate were 5.0 mg/day and 8.0 mg/week, respectively. The patients with PCP were significantly older (p < 0.05) and had more structural changes (p < 0.05) than the patients without PCP. Computed tomography of the chest revealed ground-glass opacity without interlobular septal boundaries in the majority of the patients with PCP. Three PCP patients died.
  
  
  CONCLUSIONS
  PCP may occur early in the course of adalimumab therapy in patients with RA. Careful monitoring, early diagnosis, and proper management are mandatory to secure a good prognosis for these patients.
authors.affiliation: Department of Pharmacovigilance, Graduate School of Medical and Dental Sciences, Tokyo Medical Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Watanabe
authors.forename: Ryoko
authors.initials: R
authors.lastname: Sakai
authors.forename: Ryuji
authors.initials: R
authors.lastname: Koike
authors.forename: Fumikazu
authors.initials: F
authors.lastname: Sakai
authors.forename: Haruhito
authors.initials: H
authors.lastname: Sugiyama
authors.forename: Michi
authors.initials: M
authors.lastname: Tanaka
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Komano
authors.forename: Yuji
authors.initials: Y
authors.lastname: Akiyama
authors.forename: Toshihide
authors.initials: T
authors.lastname: Mimura
authors.forename: Motohide
authors.initials: M
authors.lastname: Kaneko
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tokuda
authors.forename: Takenobu
authors.initials: T
authors.lastname: Iso
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Motegi
authors.forename: Kei
authors.initials: K
authors.lastname: Ikeda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakajima
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Taki
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Kubota
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Kodama
authors.forename: Shoji
authors.initials: S
authors.lastname: Sugii
authors.forename: Takashi
authors.initials: T
authors.lastname: Kuroiwa
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Nawata
authors.forename: Kazuko
authors.initials: K
authors.lastname: Shiozawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ogata
authors.forename: Shigemasa
authors.initials: S
authors.lastname: Sawada
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Matsukawa
authors.forename: Takahiro
authors.initials: T
authors.lastname: Okazaki
authors.forename: Masaya
authors.initials: M
authors.lastname: Mukai
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Iwahashi
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Saito
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Nanki
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Miyasaka
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Harigai
mesh_terms: D000068879:Adalimumab; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D016022:Case-Control Studies; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D045363:Pneumocystis carinii / Q000302:isolation & purification*; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis* / Q000209:etiology; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D011239:Prednisolone; D000068879:Adalimumab; D008727:Methotrexate