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

Watanabe, Kaori; Sakai, Ryoko; Koike, Ryuji; Sakai, Fumikazu; Sugiyama, Haruhito; Tanaka, Michi; Komano, Yukiko; Akiyama, Yuji; Mimura, Toshihide; Kaneko, Motohide; Tokuda, Hitoshi; Iso, Takenobu; Motegi, Mitsuru; Ikeda, Kei; Nakajima, Hiroshi; Taki, Hirofumi; Kubota, Tetsuo; Kodama, Hirotaka; Sugii, Shoji; Kuroiwa, Takashi
November 2013
Modern Rheumatology (Springer Science & Business Media B.V.);Nov2013, Vol. 23 Issue 6, p1085
Academic Journal
Objectives: 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.


Related Articles

  • Pneumocystis carinii Pneumonia: A Clinical Review. Wilkin, Aimee; Feinberg, Judith // American Family Physician;10/15/1999, Vol. 60 Issue 6, p1699 

    Discusses about Pneumocystis carinii pneumonia (PCP). Description of the infection; Risk factors and clinical presentation; Diagnosis; Management of PCP.

  • Risk Factors for Community-Acquired Pneumonia among Persons Infecte with Human Immunodeficiency... Navin, Thomas R.; Rimland, David; Lennox, Jeffrey L.; Jernigan, John; Cetron, Marty; Hightower, Allen; Roberts, Jacqueline M.; Kaplan, Jonathan E. // Journal of Infectious Diseases;1/1/2000, Vol. 181 Issue 1, p158 

    Analyzes risk factors associated with community-acquired pneumonia among persons infected with HIV. Possible pulmonary damages caused by the antecedent infection; Relationship between the anti-fungal agent fluconazole and the protective effect of the drug to pneumonia; Genetic sequence distinct...

  • Clinical features of rheumatoid arthritis-associated interstitial lung disease. Ting Wang; Xing-Ju Zheng; Bin-Miao Liang; Zong-An Liang // Scientific Reports;10/9/2015, p1 

    Interstitial lung disease (ILD) is the most common extra-articular manifestations of rheumatoid arthritis (RA) in the lung. This study aimed to identify clinical features of RA-associated ILD (RAILD). Patients with RA were retrospectively enrolled and sub-classified as RA-ILD or RA without ILD...

  • Head-to-head study with RA drugs.  // Australian Journal of Pharmacy;Jul2013, Vol. 94 Issue 1118, p30 

    The article focuses on the study ADalimumab ACTemrA (ADACTA)", which was published in the periodical "The Lancet," reveals that Actemra offers improvement in the signs and symptoms of rheumatoid arthritis (RA) for patients who require monotherapy as compared to adalimumab, as of July 1, 2013.

  • Genentech's ACTEMRA(r) Monotherapy Showed Superior Improvement in Rheumatoid Arthritis Signs and Symptoms Versus Adalimumab Monotherapy.  // Biomedical Market Newsletter;3/7/2012, Vol. 21, p1 

    The article presents information on the ADACTA (ADalimumab ACTemrA) study according to which patients receiving ACTEMRA® (tocilizumab) experienced more decrease in disease activity after 24 weeks than those who were given adalimumab monotherapy. It is further mentioned that ADACTA study...

  • Arthritis & Rheumatism: No difference in death rates among patients exposed to common rheumatoid arthritis drugs.  // Biomedical Market Newsletter;8/1/2012, Vol. 21, p1 

    The article report on a research in Sweden which found no difference in the rates of death among patients with rheumatoid arthritis (RA) who were exposed to rheumatoid arthritis drugs including adalimumab, etanercept and infliximab.

  • Temporal Trends and Factors Associated with Survival after Pneumocystis carinii Pneumonia in California, 1983–1992. Colford, John M.; Segal, Mark; Tabnak, Farzaneh; Chen, Mi; Sun, Richard; Tager, Ira // American Journal of Epidemiology;1997, Vol. 146 Issue 2, p115 

    The authors investigated quarterly trends in survival after the diagnosis of Pneumocystis carinii pneumonia for 19,607 patients in California in the decade from January 1, 1983, through December 31, 1992. Subjects included all cases for whom P. carinii pneumonia was the initial (and only)...

  • Risk factors of Pneumocystis jeroveci pneumonia in patients with systemic lupus erythematosus. Lertnawapan, Ratchaya; Totemchokchyakarn, Kitti; Nantiruj, Kanokrat; Janwityanujit, Suchela // Rheumatology International;Mar2009, Vol. 29 Issue 5, p491 

    Pneumocystis jeroveci pneumonia (PCP) is an opportunistic infection which occurs mostly in the immune-deficiency host. Although PCP infected systemic lupus erythematosus (SLE) patient carries poor outcome, no standard guideline for prevention has been established. The aim of our study is to...

  • Dynamics of Pneumocystis carinii Air Shedding During Experimental Pneumocystosis. Choukri, Firas; Aliouat, El Moukhtar; Menotti, Jean; Totet, Anne; Gantois, Nausicaa; Garin, Yves J. F.; Bergeron, Vance; Dei-cas, Eduardo; Derouin, Francis // Journal of Infectious Diseases;May2011, Vol. 203 Issue 9, p1333 

    To better understand the diffusion of Pneumocystis in the environment, airborne shedding of Pneumocystis carinii in the surrounding air of experimentally infected rats was quantified by means of a real-time polymerase chain reaction assay, in parallel with the kinetics of P. carinii loads in...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics